Active NPI
Samantha Alexandria Clark, DDS
- Pediatric Dentistry
- Polson, MT
National Provider Identifier
1174967277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 12012102A
- Practice address
- 5 4TH Ave. E.
Polson, MT 59860 - Phone
- (406) 745-3525
- Fax
- (406) 745-3529
- NPI assigned
- Apr 19, 2013
- Last updated
- Sep 10, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 390200000 | IN | |
| Pediatric Dentistry | 1223P0221X | 12012102A | IN | Primary |
Addresses
Primary practice location
5 4TH Ave. E.
Polson, MT 59860
Mailing address
P.O. Box 880
St. Ignatius, MT 59865
Phone (406) 745-3525
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 |
|---|---|---|---|
| 12012102A | IN | MD | Pediatric Dentist |
| 390200000 | IN | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441843200000",
"number": "1174967277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 880",
"city": "ST. IGNATIUS",
"state": "MT",
"postal_code": "59865",
"telephone_number": "406-745-3525",
"fax_number": "406-745-3529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 4TH AVE. E.",
"city": "POLSON",
"state": "MT",
"postal_code": "59860",
"telephone_number": "406-745-3525",
"fax_number": "406-745-3529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "SAMANTHA",
"middle_name": "ALEXANDRIA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-04-19",
"last_updated": "2015-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IN",
"license": "390200000",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IN",
"license": "12012102A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Polson, MT
- Katie Emily Carter, ND
- Melinda Lorraine Caye, LCSW
- Elizabeth Charlat
- Ryan Jeffery Christopher, MSPT
- Tracy Arnel Clairmont, LCSW
- James G Clough, DPM
- Norman Ellsworth Collins II, DC
- Confederated Salish & Kootenai Tribes of the Flathead Reservation (The Retreat Assisted Living)
- Confederated Salish & Kootenai Tribes of the Flathead Reservation (CSKT Polson Health Center Pharmacy)
- Bernadette N. Corum, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 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.