David Bryce Clark, D.D.S., M.S.D.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

12008231A Issued in IN

Practice address

1530 S Miller St
Shelbyville, IN 46176-2949

Phone

(317) 392-6166

Fax

(317) 392-6196

NPI assigned

Sep 26, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013018803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 S MILLER ST",
            "address_2": "P.O. BOX 234",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461762949",
            "telephone_number": "317-392-6166",
            "fax_number": "317-392-6196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1530 S MILLER ST",
            "city": "SHELBYVILLE",
            "state": "IN",
            "postal_code": "461762949",
            "telephone_number": "317-392-6166",
            "fax_number": "317-392-6196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DAVID",
        "middle_name": "BRYCE",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IN",
            "license": "12008231A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gloria Eun-Sun Chun
• Megan Engle Ciaccio, M.D.
• Jessica L Cielo, APRN
• City of Shelbyville & Sewage Works Operating (Shelbyville Fire Department)
• City Optical Co., Inc. (Dr Tavel Family Eye Care)
• Alisha Ann Clay
• Clear Chiropractic Shelbyville LLC (Clear Choice Chiropractic)
• Shannon Clouse
• Chloe Michael Coers
• Darrell F Cole II, RPH

• Orthodontics and Dentofacial Orthopedics Dentistry in Shelbyville, IN
• Providers in Shelbyville, IN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.