Alexander Clark, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

61486 Issued in KS

Practice address

8340 Mission Rd Ste 118
Prairie Village, KS 66206-1362

Phone

(913) 362-4488

NPI assigned

Jun 21, 2016

Last updated

May 12, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

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.

Opted out of Medicare

Yes, effective Dec 14, 2017 through Dec 14, 2027

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.

• Alexander J. Clark DDS, LLC

  • Dental Clinic/Center
  • Prairie Village, KS
  • NPI 1629680368
  NPD Authorized official
• Opdahl & Bowen DDS PC

  • Dentist
  • Independence, MO
  • NPI 1790895043
  NPD (past)

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

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1265882104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8340 MISSION RD STE 118",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662061362",
            "telephone_number": "913-362-4488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8340 MISSION RD STE 118",
            "city": "PRAIRIE VILLAGE",
            "state": "KS",
            "postal_code": "662061362",
            "telephone_number": "913-362-4488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ALEXANDER",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-21",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "61486",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2016001210",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Chrisco, DPT
• Mark C Chubb
• Julia Cindrich
• Claire L Barron PHD. Inc.
• Clark C. Chaney DDS, LLC.
• Anna Clark, DPT
• Camryn Clark
• Kaylin Clark
• Marie Kaye Clark
• Etienne Clatanoff, LPC

• Dentist in Prairie Village, KS
• Providers in Prairie Village, KS by specialty
• Dentist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.