John Warren Clark, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

3365 Issued in ME

Practice address

8 Monument Square LN
Dover Foxcroft, ME 04426-1339

Phone

(207) 564-8197

Fax

(207) 564-8489

NPI assigned

May 14, 2007

Last updated

Jan 22, 2025By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• John W. Clark PA

  • Customized Equipment (DME)
  • Bangor, ME
  • NPI 1275904435
  NPD Authorized official
• John W. Clark PA

  • Dentist
  • Bangor, ME
  • NPI 1326306085
  NPD Authorized official

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1235344052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "753 STILLWATER AVE",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013633",
            "telephone_number": "207-990-5887",
            "fax_number": "207-307-7002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 MONUMENT SQUARE LN",
            "city": "DOVER FOXCROFT",
            "state": "ME",
            "postal_code": "044261339",
            "telephone_number": "207-564-8197",
            "fax_number": "207-564-8489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOHN",
        "middle_name": "WARREN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ME",
            "license": "3365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kathleen Childs, FNP
• Kassandra Alyssa Churchill
• Felicia Cleaves, RN
• Tanya L Clement, PT, DPT
• Clinical Consultation & Counseling, P.a. (Clinical Consultation & Counseling)
• Christopher Robert Clukey, M.A.CCC-A
• Jeffrey Allen Cole, DO

• Dentist in Dover Foxcroft, ME
• Providers in Dover Foxcroft, ME by specialty
• Dentist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.

Verify at the official NPI Registry.