Peter A Clark, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

20341 Issued in TX

Practice address

Bonham Family Dentistry
101 E 9TH Street
Bonham, TX 75418

Phone

(903) 583-8023

Fax

(903) 583-1291

NPI assigned

Aug 31, 2006

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

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

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.

• DRS Peter and Lisa Clark Family and Cosmetic Dentistry

  • General Practice Dentistry
  • Bonham, TX
  • NPI 1376655357
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043322902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BONHAM FAMILY DENTISTRY",
            "address_2": "101 E 9TH STREET",
            "city": "BONHAM",
            "state": "TX",
            "postal_code": "75418",
            "telephone_number": "903-583-8023",
            "fax_number": "903-583-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BONHAM FAMILY DENTISTRY",
            "address_2": "101 E 9TH STREET",
            "city": "BONHAM",
            "state": "TX",
            "postal_code": "75418",
            "telephone_number": "903-583-8023",
            "fax_number": "903-583-1291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PETER",
        "middle_name": "A",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "20341",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "7515",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BC",
            "identifier": "86D654",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Catalyst Chiropractic PLLC
• Center Street Pharmacy Inc.
• City of Bonham
• Amy Beth Clark, LCSW, MSSW
• Lisa M Clark, DMD
• Pamela Lynn Collins Aurand, LCSW, LCDC, LMFT
• Jennifer Lynn Collins, OTR/L
• Community Health Service Agency, Inc
• Community Well TX
• Concord North Texas, PLLC

• All providers in Bonham, TX
• Dentist in Texas

• 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.