Matthew Mitchell Clark, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0401417451 Issued in VA

Practice address

716 Denbigh Blvd Ste C1
Newport News, VA 23608-4414

Phone

(757) 874-6501

NPI assigned

Feb 11, 2016

Last updated

Feb 2, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Matthew Mitchell Clark Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 27, 2026 through May 27, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• TDT Oms

  dba Hampton Roads Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Newport News, VA
  • NPI 1831476886
  NPD
• Ronald Tankersley DDS Numa Ray Lee DDS Jeffrey N Kenney DDS W Les

  • Oral and Maxillofacial Surgery (Dentist)
  • Newport News, VA
  • NPI 1295930097
  NPD (past)

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

{
    "created_epoch": "1455148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738454400000",
    "number": "1033578653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 ZACHARY PL",
            "city": "YORKTOWN",
            "state": "VA",
            "postal_code": "236931909",
            "telephone_number": "865-266-3026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 DENBIGH BLVD STE C1",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236084414",
            "telephone_number": "757-874-6501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "77 Nealy Ave",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "236652040",
            "country_code": "US",
            "telephone_number": "865-266-3026",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1859 N Lakewood Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838142661",
            "country_code": "US",
            "telephone_number": "208-667-5565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MATTHEW",
        "middle_name": "MITCHELL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-11",
        "last_updated": "2025-02-02",
        "certification_date": "2025-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "10945",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401417451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MATTHEW",
            "last_name": "CLARK",
            "middle_name": "MITCHELL",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Tanya L Claiborne, PHARM.D.
• Cariana Josephine Clanton, DO
• Anna Irene Clark, MD
• Dana Maria Clark, PA-C
• Donna Patricia Clark, NURSE PRACTITIONER
• NA'Zae Athena Clark, PA-C
• Sarah Clark, MOT
• Theresa Hitselberger Clark, MD
• Thomas W Clark, M.S., M.D., F.A.C.S.
• Tyler S Clark, DPT

• Oral and Maxillofacial Surgery (Dentist) in Newport News, VA
• Providers in Newport News, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2025; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.