Individual
JILL A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
755 SCOTT CIR, BLDG 559, HICKAM AFB, HI 96853-5399
(808) 448-6371
Mailing address
3776 ELM DR, PEARL CITY, HI 96782-3912
(808) 744-0007
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
0402203160
VA
Other
Enumeration date
04/10/2006
Last updated
08/06/2012
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