Individual
DR. JAY F. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7455 ERIE RD, LAKE SHORE PROF BLDG, DERBY, NY 14047-9305
(716) 947-4308
Mailing address
7455 ERIE RD, P.O. BOX 417, DERBY, NY 14047-9305
(716) 947-4308
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
035871
NY
Other
Enumeration date
08/27/2007
Last updated
08/27/2007
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