Dr. Tanner Jay Clark, D.D.S., M.S.
Dentist, Orthodontics and Dentofacial Orthopedics in North Liberty, IA. Individual provider (NPI-1).
NPI number1790734796
StatusActive
Last updated in NPPESJan 26, 2012
Details
- NPI
- 1790734796
- Entity type
- Individual (NPI-1)
- Name
- Dr. Tanner Jay Clark
- Credential
- D.D.S., M.S.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 8, 2006
- Last updated
- Jan 26, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223X0400X | Dentist, Orthodontics and Dentofacial Orthopedics | 08880 | IA | Yes |
Practice location
650 W. Cherry St.Suite 5
North Liberty, IA 52317
Phone 319-626-3161
Mailing address
650 W. Cherry St.Suite 5
North Liberty, IA 52317
Phone 319-626-3161
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