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Individual

DR. JAY REGAN CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
20 S PINES RD, SPOKANE VALLEY, WA 99206-5136
(509) 891-5299
(509) 891-6852
Mailing address
20 S PINES RD, SPOKANE VALLEY, WA 99206-5136
(509) 891-5299
(509) 891-6852

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7663
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5024112
WA
Enumeration date
11/16/2006
Last updated
07/09/2007
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