DR. JEFFREY M CLARK DDS NPI 1649261850

NPI Information

NPI: 1649261850
Provider Name: DR. JEFFREY M CLARK, DDS
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

PECOS Registration: Yes

Address:
1802 ROCKINGHAM AVE
BOWLING GREEN, KY
ZIP 42104
Phone: (270) 783-0064
Get Directions

DR. Jeffrey M Clark, DDS is an oral and maxillofacial surgery dentist in Bowling Green, KY with 39 years of experience. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Jeffrey M Clark, DDS NPI is 1649261850. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1802 ROCKINGHAM AVE
BOWLING GREEN, KY
ZIP 42104-348
Phone: (270) 783-0064
Fax: (270) 901-1997

The NPI 1649261850 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/4/2005 and was last updated on 9/21/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0106X	Dentist	Oral and Maxillofacial Pathology	8960	KENTUCKY	No
2	1223S0112X	Dentist	Oral and Maxillofacial Surgery	8960	KENTUCKY	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3146210	OTHER	TENNESSEE	BCBS TN
2	132568	OTHER		TRICARE
3	702005606	OTHER	TENNESSEE	CARITEN COMMERICAL INSURA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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