Individual
DR. JEFFREY M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1802 ROCKINGHAM AVE, BOWLING GREEN, KY 42104-3348
(270) 783-0064
(270) 901-1997
Mailing address
1802 ROCKINGHAM AVE, BOWLING GREEN, KY 42104-3348
(270) 783-0064
(270) 901-1997
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
8960
KY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
8960
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132568
TRICARE
—
01
—
3146210
BCBS TN
TN
01
—
702005606
CARITEN COMMERICAL INSURA
TN
Enumeration date
11/04/2005
Last updated
09/21/2021
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