MEDICARE: CLARK DENTAL ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1225636087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK DENTAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	7 BALA AVE STE 301
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-3205
Country	:	US
Telephone Number	:	215-877-9111
Fax Number	:	215-877-1524

Provider Business Practice Location Address
First Line	:	7 BALA AVE STE 301
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-3205
Country	:	US
Telephone Number	:	215-877-9111
Fax Number	:	215-877-1524

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. SAUNDRA C CLARK
Credential	:	D.M.D.
Telephone Number	:	215-877-9111

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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