Clark, Gerald A
Clark, Gerald A is an sole proprietor health care provider with primary practice located at 1218 Virginia St E Suite B, Charleston WV 25301-2951. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Clark, Gerald A can be contacted via phone (304) 342-4986.Contact Information
Primary practice address
1218 Virginia St E Suite B
Charleston WV 25301-2951
Phone: (304) 342-4986
Fax: (304) 345-4499
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 3372 | West Virginia |
Profile Details
| NPI number | 1982620779 |
|---|---|
| LBN Legal business name | Clark, Gerald A |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 14th, 2006 |
| Last updated | Jul 9th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1982620779 | NPPES |
| West Virginia | MEDICAID | 4001052-000 | |
| West Virginia | Other | 550782922-001 | |
| West Virginia | Other | 979099 |
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