Active NPI
David E. Clark, R.D.
- Registered Dietitian
- Dayton, OH
National Provider Identifier
1407093065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD.6277
- Practice address
- 4132 Sierra Park Ter
Dayton, OH 45440-3324 - Phone
- (937) 603-1021
- NPI assigned
- Jan 19, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD.6277 | OH | Primary |
Addresses
Primary practice location
4132 Sierra Park Ter
Dayton, OH 45440-3324
Mailing address
4132 Sierra Park Ter
Dayton, OH 45440-3324
Phone (937) 603-1021
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD.6277 | OH | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232323200000",
"number": "1407093065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4132 SIERRA PARK TER",
"city": "DAYTON",
"state": "OH",
"postal_code": "454403324",
"telephone_number": "937-603-1021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4132 SIERRA PARK TER",
"city": "DAYTON",
"state": "OH",
"postal_code": "454403324",
"telephone_number": "937-603-1021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "DAVID",
"middle_name": "E.",
"name_prefix": "Mr.",
"credential": "R.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-19",
"last_updated": "2009-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OH",
"license": "LD.6277",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.