# CLARK D ANDELIN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1043538705
- **Gender:** Man
- **Credential:** DMD, MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 016.0125577 | VT | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DS038552 | PA | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | MT207339 | PA | — |

## Other

- **Enumeration date:** 05/05/2010
- **Last updated:** 01/20/2017