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120 Ramsgate Sq S Ste 110 Salem OR 97302-5870 | |
| (503) 371-6000 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 120 Ramsgate Sq S Ste 110, Salem, Oregon |
| Authorized Official Name and Position | Jev A Clark (DOCTOR) |
| Authorized Official Contact | 5033716000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
120 Ramsgate Sq S Ste 110 Salem OR 97302-5870 Ph: (503) 371-6000 | 120 Ramsgate Sq S Ste 110 Salem OR 97302-5870 Ph: (503) 371-6000 |
| NPI Number | 1831686468 |
|---|---|
| Provider Enumeration Date | 04/19/2018 |
| Last Update Date | 04/19/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831686468 | NPI | - | NPPES |
| MD176989 | Other | OR | MEDICAL LICENSE |
| D10561 | Other | OR | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D10561 (Oregon) | Primary |
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