Rollins Clary, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN 17796 Issued in FL

Practice address

1116B Beville Rd
Daytona Beach, FL 32114-5743

Phone

(386) 226-2268

NPI assigned

Sep 19, 2007

Last updated

Sep 19, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 FL

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Affordable Dentures - Daytona Beach, P.a.

  • Dentist
  • Daytona Beach, FL
  • NPI 1538302625
  NPD (past) Authorized official
• Conviva Medical Center Management LLC

  dba Conviva Care Center

  • Internal Medicine Physician
  • Miami, FL
  • NPI 1649324278
  NPD (past)

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190160000000",
    "number": "1134315583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116B BEVILLE RD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321145743",
            "telephone_number": "386-226-2268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116B BEVILLE RD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321145743",
            "telephone_number": "386-226-2268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARY",
        "first_name": "ROLLINS",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-19",
        "last_updated": "2007-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 17796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destanee Joy Clark
• Kevin S Clark, M.M.S., PA-C
• Rita Clark
• Shinika Clark, NP, PMHNP
• Mark Anthony Clarke, M.D.
• Kathryn Frances Clay, MA, CAP, LMHC
• Lloyd Wayne Clayborn
• Elizabeth Cleavall
• Melissa Renae Clegg, ARNP
• Kevin Ray Clemans, FNP-BC

• Dentist in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.