Elizabeth Jane Clark, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

009894 Issued in CT

Practice address

19 Halls Rd Ste 218
Old Lyme, CT 06371-1457

Phone

(860) 434-7378

NPI assigned

Dec 4, 2007

Last updated

Mar 9, 2010By the provider in NPPES

Sex

Female

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

Enrolled in CT

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

Practice roles

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.

• Old Lyme Dental Associates LLC

  • Dental Clinic/Center
  • Old Lyme, CT
  • NPI 1942443726
  NPD (past)

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268092800000",
    "number": "1407038128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 HALLS RD STE 218",
            "address_2": "PO BOX 551",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "063711457",
            "telephone_number": "860-434-7378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 HALLS RD STE 218",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "063711457",
            "telephone_number": "860-434-7378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ELIZABETH",
        "middle_name": "JANE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-04",
        "last_updated": "2010-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "009894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cambi Pediatrics, PLLC
• Kathryn M Cambi, MD
• Circulatory Centers Connecticut, LLC
• Nicole Sun Cirilli, MS, RD, CDN
• Karen Ann Claise, NP
• William Clinton, LICENSED OPTICIAN
• Anthony Albert Corrao, D.D.S.
• Mary Cummings Satti, M.D.
• Suresh Cec Il D'Mello, M.D.
• Michael Anthony D'Occhio, D.M.D.

• General Practice Dentistry in Old Lyme, CT
• Providers in Old Lyme, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; 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.