Stephen Jay Clark, D.D.S., M.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

18886 Issued in OH

Practice address

8228 N Main St
Dayton, OH 45415-1641

Phone

(937) 454-1103

Fax

(937) 454-1140

NPI assigned

Sep 17, 2007

Sex

Male

Sole proprietor

Yes

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 OH

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

Credentials

Master of Science

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

{
    "created_epoch": "1189987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189987200000",
    "number": "1316133093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8228 NORTH MAIN STREET",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45415",
            "telephone_number": "937-454-1103",
            "fax_number": "937-454-1140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8228 N MAIN ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454151641",
            "telephone_number": "937-454-1103",
            "fax_number": "937-454-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "STEPHEN",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-17",
        "last_updated": "2007-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OH",
            "license": "18886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Michelle Clark, LSW
• Patricia Clark, CDCA
• Raquel Clark
• Regina Diane Clark
• Shane Renee Clark
• Yvonne Y. Clark, CNP
• Clark's RX LLC
• Clarke Newlin Practice, LLC (A Centered Practice)
• Dorothy W Clarke, MA RD
• Lisa-Kay Helen Clarke, CPNP-AC

• Endodontics in Dayton, OH
• Providers in Dayton, OH by specialty
• Endodontics in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.

Verify at the official NPI Registry.