Healthcare Provider Details

I. General information

NPI: 1407995426
Provider Name (Legal Business Name): JEFFREY CLARK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5709 NW RADIAL HWY
OMAHA NE
68104-4141
US

IV. Provider business mailing address

5709 NW RADIAL HWY
OMAHA NE
68104-4141
US

V. Phone/Fax

Practice location:
  • Phone: 402-551-1757
  • Fax:
Mailing address:
  • Phone: 402-551-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7262
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: