Organization
CLARK ORTHODONTICS, INC.
Active
Organization
CLARK ORTHODONTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANNER CLARK (PRESIDENT)
(319) 626-3161
Entity
Organization
Contact information
Practice address
650 W. CHERRY ST., SUITE 5, NORTH LIBERTY, IA 52317
(319) 626-3161
Mailing address
650 W. CHERRY ST., SUITE 5, NORTH LIBERTY, IA 52317
(319) 626-3161
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
08218
IA
Other
Enumeration date
07/21/2011
Last updated
01/27/2012
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