Individual
DR. JEV CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2266 MISSION ST SE, SALEM, OR 97302-1267
(503) 375-2000
Mailing address
2266 MISSION ST SE, SALEM, OR 97302-1267
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D10561
OR
Other
Enumeration date
06/01/2012
Last updated
10/18/2021
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