Individual
DR. JEFFRY STEPHEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1950 ROLAND CLARKE PL, 420, RESTON, VA 20191-1414
(703) 391-2600
(703) 391-2097
Mailing address
1950 ROLAND CLARKE PL, 420, RESTON, VA 20191-1414
(703) 391-2600
(703) 391-2097
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401008224
VA
Other
Enumeration date
01/29/2007
Last updated
07/08/2007
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