Organization
CLARK FAMILY DENTAL INC
Active
Other names
Park Avenue Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY MICHAEL CLARK DMD (DENTIST)
(715) 723-0367
Entity
Organization
Contact information
Practice address
777 PARK AVENUE, CHIPPEWA FALLS, WI 54729
(715) 723-0367
Mailing address
777 PARK AVENUE, CHIPPEWA FALLS, WI 54729
(715) 723-0367
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6137015
WI
Other
Enumeration date
01/09/2009
Last updated
01/09/2009
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