Clark, Thomas Jaggers

Clark, Thomas Jaggers is an individual health care provider with primary practice located at 5805 W Highway 22 , Crestwood KY 40014-7244. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / Dentist is his primary health care specialty. Clark, Thomas Jaggers can be contacted via phone (502) 241-7116.

Contact Information

Primary practice address
5805 W Highway 22 Crestwood KY 40014-7244
Phone: (502) 241-7116
Fax: (502) 241-2339
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 4571 Kentucky
Dental Providers / General Practice 1223G0001X 4571 Kentucky

Profile Details

NPI number 1134236359
LBN Legal business name Clark, Thomas Jaggers
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 24th, 2006
Last updated Jul 8th, 2007 - about 18 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 1134236359 NPPES
Kentucky MEDICAID 60045713

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