Brett Clark, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5014-015 Issued in WI

Practice address

6317 Odana Rd
Madison, WI 53719-1107

Phone

(608) 274-1911

Fax

(608) 274-1858

NPI assigned

Oct 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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.

• Total Care Dental, S.C.

  • General Practice Dentistry
  • Madison, WI
  • NPI 1629154430
  NPD (past) Authorized official

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360540800000",
    "number": "1073699856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6317 ODANA RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537191107",
            "telephone_number": "608-274-1911",
            "fax_number": "608-274-1858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6317 ODANA RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537191107",
            "telephone_number": "608-274-1911",
            "fax_number": "608-274-1858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "BRETT",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2013-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5014-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Gerard Clancy Jr., M.D.
• Kristian Clark-Skeens, APNP
• Allan W Clark
• Alysha Clark
• Brannen Clark, MSW
• Chelsie Imani Clark, MD
• Deborah Jean Clark, CMT
• Jeffrey Clark, PHARMD
• Jenny Esther Clark, MSW, LCSW
• Jimmy Clark Jr., P.A. - C

• General Practice Dentistry in Madison, WI
• Providers in Madison, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2013; 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.