Individual provider · NPI-1

Clark D Andelin, DMD, MD

Dentist, Oral and Maxillofacial Surgery · Philadelphia, PA

NPI number1043538705
StatusActive
Last updated in NPPESJan 20, 2017

Details

NPI
1043538705
Entity type
Individual (NPI-1)
Name
Clark D Andelin
Credential
DMD, MD
Sex
Male
Sole proprietor
No
Enumeration date
May 5, 2010
Last updated
Jan 20, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223S0112X Dentist, Oral and Maxillofacial SurgeryDS038552PAYes
204E00000X Oral & Maxillofacial SurgeryMT207339PA
1223S0112X Dentist, Oral and Maxillofacial Surgery016.0125577VT

Practice location

3400 Spruce St
Philadelphia, PA 19104-4206

Phone 215-662-6176

Mailing address

3400 Spruce St
Philadelphia, PA 19104-4206

Phone 215-662-6176

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