Individual
DR. TANNER IRELAND CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
319 NE VIVION RD, KANSAS CITY, MO 64118-4510
(816) 459-0000
Mailing address
5906 W 57TH ST, MISSION, KS 66202-1949
(913) 293-7527
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2024019621
MO
Other
Enumeration date
05/31/2024
Last updated
05/31/2024
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