Christopher Clark, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11067 Issued in TN

Practice address

60 Market Center Dr
Collierville, TN 38017-7077

Phone

(901) 850-7338

NPI assigned

Jun 5, 2019

Last updated

Jun 11, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Thames Family Dentistry

  • Preferred Provider Organization
  • Collierville, TN
  • NPI 1396124152
  NPD (past)
• Nettleton Dental LLC

  • Dental Clinic/Center
  • Nettleton, MS
  • NPI 1780303677
  NPD (past)

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1205494127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 257",
            "city": "CARROLLTON",
            "state": "MS",
            "postal_code": "389170257",
            "telephone_number": "901-484-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MARKET CENTER DR",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380177077",
            "telephone_number": "901-850-7338"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "228 Main St",
            "address_purpose": "LOCATION",
            "city": "Nettleton",
            "state": "MS",
            "postal_code": "388586012",
            "country_code": "US",
            "telephone_number": "662-963-7338",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHRISTOPHER",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-05",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "4050-19",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Churchwell Pediatric Dentistry (Dr Caroline Churchwell Dr Molly Churchwell)
• Caroline H Churchwell, DDS
• Molly M Churchwell, DDS
• Chase Clanton, DPT
• Clariti Eye Care, LLC
• Stephanie Yau Cline, APRN, WHNP
• Gary Dean Clouse, DPT
• Lisa Collier
• Collierville Eyecare PLLC
• Collierville Family Health PLLC

• General Practice Dentistry in Collierville, TN
• Providers in Collierville, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.