Organization
SMART SMILES UTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANNER M CLARK DMD (MANAGER)
(801) 649-4222
Entity
Organization
Contact information
Practice address
10597 S BEACH COMBER WAY, SOUTH JORDAN, UT 84009-6132
(801) 649-4222
Mailing address
10597 S BEACH COMBER WAY, SOUTH JORDAN, UT 84009-6132
(801) 649-4222
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9860439-9921
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9860439-9921
—
UT
Enumeration date
08/31/2018
Last updated
08/31/2018
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