Organization
CLARK DENTAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TANNER M CLARK DMD (DENTIST/OWNER)
(208) 317-8555
Entity
Organization
Contact information
Practice address
9844 S 1300 E STE 360, SANDY, UT 84094-4698
(801) 571-6999
(801) 576-7507
Mailing address
10597 S BEACH COMBER WAY, SOUTH JORDAN, UT 84009-6132
(484) 278-1169
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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