David a Clark DDS PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

60023580 Issued in WA

Legal business name

DAVID A CLARK DDS PLLC

Practice address

4209 Tieton Dr Ste 102
Yakima, WA 98908-3377

Phone

(509) 966-2230

Fax

(509) 966-8812

NPI assigned

Feb 3, 2011

Organization subpart

No

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

Authorized official

Name

Dr. David Allen Clark, DDS

Title

Owner

Phone

(509) 966-2233

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

David a Clark DDS PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• David a Clark DDS PLLC

  • General Practice Dentistry
  • Yakima, WA
  • NPI 1073936837
  NPD tax ID

Locations

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

{
    "created_epoch": "1296691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296691200000",
    "number": "1053617308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4209 TIETON DR STE 102",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083377",
            "telephone_number": "509-966-2230",
            "fax_number": "509-966-8812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4209 TIETON DR STE 102",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083377",
            "telephone_number": "509-966-2230",
            "fax_number": "509-966-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID A CLARK DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-03",
        "last_updated": "2011-02-03",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-966-2233",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "60023580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124194972",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962668202",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marta Jo Davadi, RN
• Andrew Allan Davenport, D.O.
• Ariella Davenport
• Nathaniel A Davenport, MD
• Peggy Davenport
• David a Clark DDS PLLC
• David E Moore DDS, PS
• David R Brown DDS PS
• Renee David, LICSW
• Ryan James David, D.O.

• Dentist in Yakima, WA
• Providers in Yakima, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; 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.