Organization
SENIOR SMILES UTAH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TANNER M. CLARK DMD (OWNER/DENTIST)
(801) 415-6847
Entity
Organization
Contact information
Practice address
10597 S BEACH COMBER WAY, SOUTH JORDAN, UT 84009-6132
(801) 415-6847
Mailing address
10597 S BEACH COMBER WAY, SOUTH JORDAN, UT 84009-6132
(208) 317-8555
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/15/2020
Last updated
02/15/2020
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