NPIMap

Individual provider Active NPI

Kirkland Woodruff Clark III, D.M.D

  • Dentist
  • Inman, SC
National Provider Identifier
1164675252
Registry record updated Nov 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
SC4457 Issued in SC
Practice address
8810 Highway 9
Inman, SC 29349-8718
Phone
(864) 592-1647
Fax
(864) 592-0630
NPI assigned
Nov 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X SC4457 SC Primary

Addresses

Primary practice location

8810 Highway 9
Inman, SC 29349-8718

Mailing address

8810 Highway 9
PO Box 38
Inman, SC 29349-8718
Phone (864) 592-1647

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

LicenseStateTypeSpecialty
SC4457SCMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Hush DSM LLC Current Accepting new patients
Progrin Dental of Boiling Springs LLC Past Accepting new patients
Lake Bowen Dental Dentist Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1225670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225670400000",
    "number": "1164675252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8810 HIGHWAY 9",
            "address_2": "PO BOX 38",
            "city": "INMAN",
            "state": "SC",
            "postal_code": "293498718",
            "telephone_number": "864-592-1647",
            "fax_number": "864-592-0630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8810 HIGHWAY 9",
            "city": "INMAN",
            "state": "SC",
            "postal_code": "293498718",
            "telephone_number": "864-592-1647",
            "fax_number": "864-592-0630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK III",
        "first_name": "KIRKLAND",
        "middle_name": "WOODRUFF",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-03",
        "last_updated": "2008-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "SC4457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Inman, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2008; 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.