Kellan Clark

NPI #1366050296 in West Valley City, Utah

Provider Information

NPI Number
1366050296
Entity Type
Individual
Name
Kellan Clark
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Dentist
Enumeration Date
Jul 16, 2020
Last Updated
Jul 16, 2020

Practice Location

Address
2792 S 5600 W
State
Utah
ZIP Code
84120-5590
Phone
(801) 204-9889

Specialties & Taxonomy Codes

Specialty
Dentist

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