Individual
DR. VINCENT JEROME CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1437 PORTSMOUTH BLVD., PORTSMOUTH, VA 23704
(757) 397-2322
Mailing address
1437 PORTSMOUTH BLVD., PORTSMOUTH, VA 23704
(757) 397-2322
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
05541
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
274307
ANTHEM
—
05
—
9178689
—
VA
Enumeration date
08/07/2006
Last updated
07/08/2007
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