Taylor Clark, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

6577 Issued in AZ

Practice address

3 Road 6523
Kirtland, NM 87417-9452

Phone

(505) 598-6800

NPI assigned

Jul 31, 2006

Last updated

Aug 9, 2011By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

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.

• Cibola General Hospital Corporation

  dba Cibola General Hospital

  • Critical Access Hospital
  • Grants, NM
  • NPI 1780677039
  Medicare reassignment NPD
• Summit Family Dental of Kirtland, LLC

  • General Practice Dentistry
  • Kirtland, NM
  • NPI 1710215439
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312848000000",
    "number": "1336155571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 ROAD 6523",
            "city": "KIRTLAND",
            "state": "NM",
            "postal_code": "874179452",
            "telephone_number": "505-598-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 ROAD 6523",
            "city": "KIRTLAND",
            "state": "NM",
            "postal_code": "874179452",
            "telephone_number": "505-598-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TAYLOR",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2011-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "6577",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "3385",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "947963",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cara Alvaro, MBA
• Kaidan Arnold
• Krystelle Boyd
• Nathaniel Cayaditto
• Melissa Christianson, RN BSN
• Annika Coleman
• Cody Burnell Coleman, DDS
• Jeffrey D. Cooper, AU.D.
• Jessica Dalton, RN
• Michael Darais

• Dentist in Kirtland, NM
• Providers in Kirtland, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; 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.