NPIMap

Individual provider Active NPI

Lance D. Clark, DMD

  • Dentist
  • Albuquerque, NM
National Provider Identifier
1194960914
Registry record updated Jan 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD3584 Issued in NM
Practice address
1698 Rio Bravo Blvd SW
Albuquerque, NM 87105-6027
Phone
(505) 247-2717
NPI assigned
Dec 8, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 23, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DD3584 NM Primary
Dentist 122300000X 1206 WY

Addresses

Primary practice location

1698 Rio Bravo Blvd SW
Albuquerque, NM 87105-6027

Mailing address

1698 Rio Bravo Blvd SW
Albuquerque, NM 87105-6027
Phone (505) 247-2717

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
DD3584NMMDDentist
1206WYMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Partners of Rio Bravo LLP Past Accepting new patients

Organizations & group practices 1

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": "1228694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327276800000",
    "number": "1194960914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1698 RIO BRAVO BLVD SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871056027",
            "telephone_number": "505-247-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1698 RIO BRAVO BLVD SW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871056027",
            "telephone_number": "505-247-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LANCE",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-08",
        "last_updated": "2012-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD3584",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WY",
            "license": "1206",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; 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.