Individual
CLARK D ANDELIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-6176
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-6176
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
016.0125577
VT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS038552
PA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
MT207339
PA
Other
Enumeration date
05/05/2010
Last updated
01/20/2017
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