Clark Dental P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9860439-9921 Issued in UT

Legal business name

CLARK DENTAL P.C.

Practice address

10597 S Beach Comber Way
South Jordan, UT 84009-6132

Phone

(208) 317-8555

NPI assigned

Aug 10, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tanner Mark Clark, DMD

Title

President

Phone

(208) 317-8555

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1902321045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10597 S BEACH COMBER WAY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840096132",
            "telephone_number": "208-317-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10597 S BEACH COMBER WAY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840096132",
            "telephone_number": "208-317-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK DENTAL P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-10",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TANNER",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-317-8555",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "9860439-9921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3003062",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Todd Lyal Christensen, DMD
• Sara Kathleen Christman, PHD
• Jordon Kamakilaonalani Ciriako
• City of South Jordan
• City of South Jordan
• Brianna Clark
• Cameron Clark
• Elizabeth Clark
• Shay Clark, APC
• Thomas Edward Clark, OD

• General Practice Dentistry in South Jordan, UT
• Providers in South Jordan, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.