Callee Cosby Clark, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

3621-11 Issued in MS

Practice address

2530 N 8TH St
Suite 106
Grand Junction, CO 81501-8857

Phone

(970) 243-7392

Fax

(970) 243-8086

NPI assigned

Jul 20, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Callee Elizabeth Cosby Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 23, 2023 through Jan 23, 2027

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Cosby Endodontics

  • Endodontics
  • Grand Junction, CO
  • NPI 1134809205
  NPD Authorized official

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

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403827200000",
    "number": "1326278797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 N 8TH ST",
            "address_2": "SUITE 106",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018857",
            "telephone_number": "970-243-7392",
            "fax_number": "970-243-8086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 N 8TH ST",
            "address_2": "SUITE 106",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815018857",
            "telephone_number": "970-243-7392",
            "fax_number": "970-243-8086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CALLEE",
        "middle_name": "COSBY",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-07-20",
        "last_updated": "2014-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MS",
            "license": "3621-11",
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CO",
            "license": "DEN.00202198",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CALLEE",
            "last_name": "COSBY",
            "middle_name": "ELIZABETH",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert S Citkovic, PA
• City of Grand Junction
• City of Grand Junction
• Cizar LLC
• Rd Clare, FNP
• Darrel Christian Clark, DO
• Elizabeth Clark, MA, LPC
• Haley M Clark, PT, DPT
• Jillian Clark
• Larry Cromwell Clark, PHARM.D., M.S.

• Endodontics in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Endodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.