| Clark Dental Clark | |
|
2180 E 4500 S Salt Lake City UT 84117-4434 | |
| (801) 272-8609 | |
| Not Available |
| Full Name | Clark Dental Clark |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2180 E 4500 S, Salt Lake City, Utah |
| Authorized Official Name and Position | David Matthew Clark (DENTIST) |
| Authorized Official Contact | 8012728609 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clark Dental Clark 2180 E 4500 S Salt Lake City UT 84117-4434 Ph: (801) 272-8609 | Clark Dental Clark 2180 E 4500 S Salt Lake City UT 84117-4434 Ph: (801) 272-8609 |
| NPI Number | 1538572136 |
|---|---|
| Provider Enumeration Date | 06/11/2014 |
| Last Update Date | 06/11/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538572136 | NPI | - | NPPES |
| 1902193253 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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