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Individual

TINA MARIE CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1539 JACKSON ST, PORTSMOUTH, OH 45662-4480
(740) 981-6276
Mailing address
VA MEDICAL CENTER, 17273 STATE ROUTE 104, CHILLICOTHE, OH 45601-0999
(740) 773-1141

Taxonomy

Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
51.015003
OH

Other

Enumeration date
06/16/2023
Last updated
06/16/2023
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