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Individual

MR. JAN DEAN CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
300 NO WILLSON, 602F, BOZEMAN, MT 59715
(406) 586-5318
(406) 586-1635
Mailing address
1125 W KAGY BLVD STE 101, BOZEMAN, MT 59715-5879
(406) 586-5318
(406) 586-1635

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
79
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0390091
MT
Enumeration date
01/08/2007
Last updated
10/01/2024
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