Individual
JORDAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1901 RUDY LN, LOUISVILLE, KY 40207-1270
(502) 208-1516
Mailing address
319 S BAYLY AVE, LOUISVILLE, KY 40206-2506
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11123
KY
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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