Reuben Justus Clark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

57075 Issued in CA

Practice address

4420 Town Center Blvd Ste 280
El Dorado Hills, CA 95762-7138

Phone

(916) 358-8722

Fax

(916) 358-8719

NPI assigned

Jun 12, 2008

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clark Dental a Professional Dental Corporation

  dba Clark Dental General and Cosmetic dentistry

  • General Practice Dentistry
  • El Dorado Hills, CA
  • NPI 1508136748
  NPD (past) Authorized official
• Smith Dental Corporation

  • General Practice Dentistry
  • Sacramento, CA
  • NPI 1699721688
  NPD (past)

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647820800000",
    "number": "1013177062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4420 TOWN CENTER BLVD",
            "address_2": "280",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957627134",
            "telephone_number": "916-251-6810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 TOWN CENTER BLVD STE 280",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957627138",
            "telephone_number": "916-358-8722",
            "fax_number": "916-358-8719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "REUBEN",
        "middle_name": "JUSTUS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-12",
        "last_updated": "2022-03-21",
        "certification_date": "2022-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "57075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Christman
• CHW Medical Foundation (Mercy Medical Group, a Service of CHW Medical Foundation)
• Ciardella Therapy & Family Wellness, Inc. (The Path Wellness Center)
• Kimberly Ann Ciardella, LMFT
• Clark Dental a Professional Dental Corporation (Clark Dental General and Cosmetic dentistry)
• Amber Clay
• James Kirk Clopton, MD
• Taylor Raye Coate
• Zachary Coates
• Jamie Lee Cobarrubias Hurtt

• General Practice Dentistry in El Dorado Hills, CA
• Providers in El Dorado Hills, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.