Michael V. Clark, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

1108 Issued in WY

Practice address

6900 Yellowtail Rd
Suite 100
Cheyenne, WY 82009-6102

Phone

(307) 635-9251

Fax

(307) 635-9218

NPI assigned

Mar 16, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Braces U Wyoming PC

  • Dental Clinic/Center
  • Cheyenne, WY
  • NPI 1669916334
  NPD (past)
• Children'S Dentistry LLC

  • Pediatric Dentistry
  • Cheyenne, WY
  • NPI 1649488743
  NPD (past)

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386778520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 YELLOWTAIL RD",
            "address_2": "SUITE 100",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820096102",
            "telephone_number": "307-635-9251",
            "fax_number": "307-635-9218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 YELLOWTAIL RD",
            "address_2": "SUITE 100",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820096102",
            "telephone_number": "307-635-9251",
            "fax_number": "307-635-9218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHAEL",
        "middle_name": "V.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WY",
            "license": "1108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119846700",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jackeline Clark
• Jeffrey Clark
• Kendra E. Clark, CPS
• Liam Gerhardt Clark, MD
• Lindsey Ann Clark, FNP-C
• Samantha N Clark
• Jason Halsey Clarke, M.D.
• Clean Clinic Wyoming
• Meaghan Climis
• Clinical Decision Medical Services, LLC

• Pediatric Dentistry in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Pediatric Dentistry in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.