Active NPI
Timothy Paul Clark, DDS
- General Practice Dentistry
- Becker, MN
National Provider Identifier
1194800946
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10140
- Practice address
- 12392 Pleasant Ave.
Becker, MN 55308-0098 - Phone
- (763) 261-5350
- Fax
- (763) 262-5351
- NPI assigned
- Oct 26, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10140 | MN | Primary |
Addresses
Primary practice location
12392 Pleasant Ave.
Becker, MN 55308-0098
Mailing address
PO Box 98
12392 Pleasant Ave.
Becker, MN 55308-0098
Phone (763) 261-5350
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6B403CL | Other | MN | BCBS PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151027002080 | MN | Order and Referring Only - Oral Surgery | 0749599082 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10140 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194800946",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 98",
"address_2": "12392 PLEASANT AVE.",
"city": "BECKER",
"state": "MN",
"postal_code": "553080098",
"telephone_number": "763-261-5350",
"fax_number": "763-262-5351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12392 PLEASANT AVE.",
"city": "BECKER",
"state": "MN",
"postal_code": "553080098",
"telephone_number": "763-261-5350",
"fax_number": "763-262-5351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TIMOTHY",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "10140",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "6B403CL",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Becker, MN
- Brandon Buesgens, D.C.
- Toni Iris Buesgens, DC
- Centracare Clinic (CentraCare - Becker Clinic)
- Central Minnesota Anesthesia Providers, PA
- Laurie L. Chapman, N.D.
- Danielle M Cohen, CNP, APRN
- Current Accessibility Solutions LLC
- Dr. Stephanie Gruenes Center for Cosmetic Dentistry PA
- Eagan Eye Clinic LLC
- Essential Grace Therapy, PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.