Clark Orthodontics, PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

19032 Issued in FL

Legal business name

CLARK ORTHODONTICS, PLLC

Practice address

5555 Roanoke TRL
Tallahassee, FL 32312-4868

Phone

(850) 385-2822

NPI assigned

Feb 16, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Andrew ClarkNPI 1992017164

Title

President

Phone

(850) 385-2822

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Andrew Edward Clark, DMD

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Tallahassee, FL
  • NPI 1992017164
  NPD (past) Authorized official

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

{
    "created_epoch": "1424044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424044800000",
    "number": "1154712818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 ROANOKE TRL",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323124868",
            "telephone_number": "850-385-2822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 ROANOKE TRL",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323124868",
            "telephone_number": "850-385-2822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK ORTHODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-16",
        "last_updated": "2015-02-16",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-385-2822",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "19032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; 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.