DR. Tanner Mark Clark, D.M.D.
NPI #1679841811 in Philadelphia, Pennsylvania
Provider Information
- NPI Number
- 1679841811
- Entity Type
- Individual
- Name
- DR. Tanner Mark Clark, D.M.D.
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Dentist - General Practice
- Credential
- D.M.D.
- Enumeration Date
- Dec 2, 2011
- Last Updated
- Apr 25, 2016
Practice Location
- Address
- 2203 FITZWATER ST UNIT 1
- City
- Philadelphia
- State
- Pennsylvania
- ZIP Code
- 19146-1132
- Phone
- (208) 317-8555
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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