Adam Tanner Clark, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

7396 Issued in AZ

Practice address

706 E Bell Rd
Suite 106
Phoenix, AZ 85022-6640

Phone

(602) 996-2600

Fax

(602) 314-6497

NPI assigned

Aug 8, 2008

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• North Valley Endodontics, P.a.

  • Endodontics
  • Phoenix, AZ
  • NPI 1659308641
  NPD (past)

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

{
    "created_epoch": "1218153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275609600000",
    "number": "1366698490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 PAMELA ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057153",
            "telephone_number": "909-522-6392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 E BELL RD",
            "address_2": "SUITE 106",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850226640",
            "telephone_number": "602-996-2600",
            "fax_number": "602-314-6497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ADAM",
        "middle_name": "TANNER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-08",
        "last_updated": "2010-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "7396",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "55257",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "7396",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "55257",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard J Claridge, M.D.
• Clarity Counseling and Consulting LLC
• Clarity Living LLC
• Clark Medical and Post-Acute Services, LLC
• Clark Medical, PLLC
• Amy Marie Clark
• Andrea Clark, PNP- PC/AC
• April Ann Clark, MA
• Aubrey Clark
• Benjamin Alex Clark, LCSW

• All providers in Phoenix, AZ
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2010; 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.