Individual
DR. JAYSON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4274 N EAGLE ROAD, BOISE, ID 83713
(208) 938-8228
Mailing address
1781 W MILAZZO ST, MERIDIAN, ID 83646-5099
(208) 870-3028
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4363
ID
Other
Enumeration date
06/21/2011
Last updated
06/21/2011
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