Organization
CLARK DENTAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANNER MARK CLARK DMD (PRESIDENT)
(208) 317-8555
Entity
Organization
Contact information
Practice address
10597 S BEACH COMBER WAY, SOUTH JORDAN, UT 84009-6132
(208) 317-8555
Mailing address
10597 S BEACH COMBER WAY, SOUTH JORDAN, UT 84009-6132
(208) 317-8555
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9860439-9921
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3003062
—
UT
Enumeration date
08/10/2017
Last updated
07/21/2022
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