NPIMap

Individual provider Active NPI

Clark David Larson, DDS

  • Dentist
  • San Tan Valley, AZ
National Provider Identifier
1326368432
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8141 Issued in AZ
Practice address
270 E Hunt Hwy Ste 14
San Tan Valley, AZ 85143-4964
Phone
(480) 888-2271
NPI assigned
Jun 11, 2010
Last updated
Sep 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 25454 TX
Dentist 122300000X 8141 AZ Primary

Addresses

Primary practice location

270 E Hunt Hwy Ste 14
San Tan Valley, AZ 85143-4964

Mailing address

24433 S 201St CT
Queen Creek, AZ 85142-5097
Phone (480) 310-7721

Other practice location 1

440 State Highway 78
Ste 200
Lavon, TX 75166-1265
Phone (972) 853-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
8141AZMDDentist
25454TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
1St Access Dental LLP Current Accepting new patients
KG1 PLLC General Practice Current Accepting new patients
CLMT Enterprises, PLLC General Practice PastSince Sep 27, 2020 Accepting new patients
Johnson Ranch Family Dentistry General Practice PastSince Sep 27, 2020 Accepting new patients
Lavon Family Dental General Practice Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1276214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1326368432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24433 S 201ST CT",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851425097",
            "telephone_number": "480-310-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 E HUNT HWY STE 14",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851434964",
            "telephone_number": "480-888-2271"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "440 State Highway 78",
            "address_2": "Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lavon",
            "state": "TX",
            "postal_code": "751661265",
            "country_code": "US",
            "telephone_number": "972-853-2100",
            "fax_number": "972-853-2500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSON",
        "first_name": "CLARK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-11",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "25454",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "8141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Tan Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.