Clark Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2007014394 Issued in MO

Legal business name

CLARK FAMILY DENTISTRY

Practice address

1331 Village Dr
Saint Joseph, MO 64506-2457

Phone

(816) 232-1444

Fax

(816) 279-1450

NPI assigned

Aug 27, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Heather Elise Clark, DDSNPI 1609043587

Title

President/Dentist

Phone

(816) 232-1444

Specialties & licenses 1

Addresses

Other names 1

• Heather E. Clark Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather Elise Clark, DDS

  • General Practice Dentistry
  • Saint Joseph, MO
  • NPI 1609043587
  NPD (past) Authorized official
• Ashley Rose Deacy, DMD

  • General Practice Dentistry
  • Saint Joseph, MO
  • NPI 1710479894
  NPD (past)
• Kenton C. Freeman, MD

  • Physical Medicine & Rehabilitation Physician
  • Saint Joseph, MO
  • NPI 1043291297
  NPD (past)

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

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219795200000",
    "number": "1053568477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 VILLAGE DR",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062457",
            "telephone_number": "816-232-1444",
            "fax_number": "816-279-1450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 VILLAGE DR",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645062457",
            "telephone_number": "816-232-1444",
            "fax_number": "816-279-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-27",
        "last_updated": "2008-08-27",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "ELISE",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "816-232-1444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2007014394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heather E. Clark",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christensen Orthodontics, LLC
• Don Christensen, LCSW
• Jacob Charles Christian, DO
• Douglas Chyatte, M.D.
• City of St. Joseph
• Alexavier Maximus Clark
• Heather Elise Clark, DDS
• Robert C Clark, M.D.
• Vickie J Clark, MSW PLCSW
• Tennyson Clary, LMSW, CADC, SQP

• General Practice Dentistry in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; 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.