Active NPI
Saundra C Clark, DMD
- Dentist
- Philadelphia, PA
National Provider Identifier
1053592592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS031094L
- Practice address
- 4401 Conshohocken Ave
Dental Suite
Philadelphia, PA 19131-1553 - Phone
- (215) 877-9111
- NPI assigned
- Nov 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS031094L | PA | Primary |
Addresses
Primary practice location
4401 Conshohocken Ave
Dental Suite
Philadelphia, PA 19131-1553
Mailing address
4401 Conshohocken Ave
Dental Suite
Philadelphia, PA 19131-1553
Phone (215) 877-9111
Medicare participation
Medicare enrollment files- 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
- Opted out of Medicare
- Yes, effective Feb 8, 2016 through Feb 8, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS031094L | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196035200000",
"number": "1053592592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4401 CONSHOHOCKEN AVE",
"address_2": "DENTAL SUITE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311553",
"telephone_number": "215-877-9111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4401 CONSHOHOCKEN AVE",
"address_2": "DENTAL SUITE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311553",
"telephone_number": "215-877-9111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "SAUNDRA",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-26",
"last_updated": "2007-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS031094L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.