Individual
DR. JEFFERSON CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2350 PROFESSIONAL DR, SUITE 100, ROSEVILLE, CA 95661-7747
(916) 783-0122
Mailing address
2350 PROFESSIONAL DR, SUITE 100, ROSEVILLE, CA 95661-7747
(916) 783-0122
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
63225
CA
Other
Enumeration date
11/10/2016
Last updated
11/10/2016
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