Individual
DR. ADAM TANNER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
706 E BELL RD, SUITE 106, PHOENIX, AZ 85022-6640
(602) 996-2600
(602) 314-6497
Mailing address
3131 PAMELA ST, PRESCOTT, AZ 86305-7153
(909) 522-6392
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
55257
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7396
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55257
STATE LICENSE
CA
01
—
7396
DENTAL LICENSE
AZ
Enumeration date
08/08/2008
Last updated
06/04/2010
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