Travis Clark DDS LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

TRAVIS CLARK DDS LLC

Doing business as

Family Dental Care Of Lebanon

Practice address

1248 Columbus Ave Ste 8
Lebanon, OH 45036-9005

Phone

(513) 932-0432

Fax

(513) 932-0152

NPI assigned

Sep 8, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Travis Clark, DDSNPI 1548344203

Title

Dentist

Phone

(614) 937-0509

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Family Dental Care Of Lebanon Doing business as

Locations

Practitioners 1

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

• Travis Clark, DDS

  • Dentist
  • Lebanon, OH
  • NPI 1548344203
  NPD Authorized official

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1093329914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7845 PLANTATION DR",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450405944",
            "telephone_number": "614-937-0509",
            "fax_number": "513-932-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1248 COLUMBUS AVE STE 8",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450369005",
            "telephone_number": "513-932-0432",
            "fax_number": "513-932-0152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAVIS CLARK DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-08",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "614-937-0509",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2668466",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Dental Care Of Lebanon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Lebanon, OH
• Providers in Lebanon, OH by specialty
• Dental Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.