Clark, Jeffrey M

Clark, Jeffrey M is an sole proprietor health care provider with primary practice located at 1802 Rockingham Ave , Bowling Green KY 42104-3348. He recently has 2 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Pathology, Dental Providers / Oral and Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is his primary health care specialty. Clark, Jeffrey M can be contacted via phone (270) 783-0064.

Contact Information

Primary practice address
1802 Rockingham Ave Bowling Green KY 42104-3348
Phone: (270) 783-0064
Fax: (270) 901-1997
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Pathology 1223P0106X 8960 Kentucky
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 8960 Kentucky

Profile Details

NPI number 1649261850
LBN Legal business name Clark, Jeffrey M
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 4th, 2005
Last updated Sep 21st, 2021 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649261850 NPPES
Tennessee Other 3146210 BCBS TN
Tennessee Other 132568 BCBS TN
Tennessee Other 702005606 BCBS TN

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