Provider Demographics
NPI:1225636087
Name:CLARK DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CLARK DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-877-9111
Mailing Address - Street 1:7 BALA AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3205
Mailing Address - Country:US
Mailing Address - Phone:215-877-9111
Mailing Address - Fax:215-877-1524
Practice Address - Street 1:7 BALA AVE STE 301
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3205
Practice Address - Country:US
Practice Address - Phone:215-877-9111
Practice Address - Fax:215-877-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty