Organization
DENTICARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TANNER M CLARK DMD (OWNER)
(208) 317-8555
Entity
Organization
Contact information
Practice address
10597 S BEACH COMBER WAY, SOUTH JORDAN, UT 84009-6132
(801) 447-5022
Mailing address
10597 S BEACH COMBER WAY, SOUTH JORDAN, UT 84009-6132
(208) 317-8555
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/09/2018
Last updated
02/09/2018
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