Individual
ELIZABETH JANE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
19 HALLS RD STE 218, OLD LYME, CT 06371-1457
(860) 434-7378
Mailing address
19 HALLS RD STE 218, PO BOX 551, OLD LYME, CT 06371-1457
(860) 434-7378
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
009894
CT
Other
Enumeration date
12/04/2007
Last updated
03/09/2010
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