Dennis P Clark, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D7829 Issued in OR

Practice address

9430 SW Coral St
Suite 200
Tigard, OR 97223-6691

Phone

(503) 245-1100

NPI assigned

Apr 12, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 6, 2015 through Apr 6, 2027

Medicare enrollment (NPD)

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.

• Dennis P. Clark, D.M.D., P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Tigard, OR
  • NPI 1235249160
  NPD (past) Authorized official
• Clark Oral Surgery and Implant Center

  • Dental Clinic/Center
  • Tigard, OR
  • NPI 1598285777
  NPD (past)

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418601600000",
    "number": "1386868370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9430 SW CORAL ST",
            "address_2": "SUITE 200",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236691",
            "telephone_number": "503-245-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9430 SW CORAL ST",
            "address_2": "SUITE 200",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236691",
            "telephone_number": "503-245-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DENNIS",
        "middle_name": "P",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-12",
        "last_updated": "2014-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D7829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adry Snorradottir Clark, PHD
• Alice Halsey Clark, RN
• Ashley Rose Clark
• Barbara Anne Clark, P.T.
• Daniel Clark, MS
• Erica Clark
• Kyra Clark
• Latorria Clark
• Madeline Clark
• Tylee Cooper Clark, CSWA

• Oral and Maxillofacial Surgery (Dentist) in Tigard, OR
• Providers in Tigard, OR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.