Active NPI
Brian Edward Clark, DDS
- Dentist
- Garfield HTS, OH
National Provider Identifier
1083756274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 15130
- Practice address
- 5544 Turney Rd
Garfield HTS, OH 44125-3780 - Phone
- (216) 581-8931
- Fax
- (216) 581-8931
- NPI assigned
- Feb 13, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 15130 | OH | Primary |
Addresses
Primary practice location
5544 Turney Rd
Garfield HTS, OH 44125-3780
Mailing address
5544 Turney Rd
Garfield HTS, OH 44125-3780
Phone (216) 581-8931
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0310621 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15130 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083756274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5544 TURNEY RD",
"city": "GARFIELD HTS",
"state": "OH",
"postal_code": "441253780",
"telephone_number": "216-581-8931",
"fax_number": "216-581-8931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5544 TURNEY RD",
"city": "GARFIELD HTS",
"state": "OH",
"postal_code": "441253780",
"telephone_number": "216-581-8931",
"fax_number": "216-581-8931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "BRIAN",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "15130",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0310621",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Garfield HTS, OH
- Diane Chernin, M.D.
- Chiropractic & Spinal Rehabilitation Clinic, Inc.
- Bridgette Celine Chuderewicz, COTA/L
- CHV Home Medical Equipment
- Danielle Cichon, DPT
- Sheila Clark, LCDCIII
- Cleveland Eye Care & Surgery, Inc.
- Cleveland Eye Specialists and Consultants, Inc.
- Cleveland Orthopaedic Associates Inc
- Cleveland Pulmonary Associates Corp
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.