Organization
CLARK DENTAL CLARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID MATTHEW CLARK DDS (DENTIST)
(801) 272-8609
Entity
Organization
Contact information
Practice address
2180 E 4500 S, SALT LAKE CITY, UT 84117-4434
(801) 272-8609
Mailing address
2180 E 4500 S, SALT LAKE CITY, UT 84117-4434
(801) 272-8609
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902193253
—
UT
Enumeration date
06/11/2014
Last updated
06/11/2014
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