Dakota B Clark, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6493 Issued in AL

Practice address

1450 1St Ave SW
Jacksonville, AL 36265-3329

Phone

(256) 435-2007

Fax

(256) 435-4669

NPI assigned

Jun 6, 2018

Last updated

Oct 15, 2020By the provider in NPPES

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

Enrolled in AL

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

Locations

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.

• Dakota B Clark DMD LLC

  dba Jacksonville Comprehensive Dentistry

  • General Practice Dentistry
  • Jacksonville, AL
  • NPI 1972101426
  NPD Authorized official
• Al Dental Professionals PC

  • General Practice Dentistry
  • Anniston, AL
  • NPI 1821832585
  NPD (past)
• Bruce E. Cunningham, DMD PC

  • General Practice Dentistry
  • Jacksonville, AL
  • NPI 1982173084
  NPD (past)
• Travis P. Phillips, DMD, LLC

  • General Practice Dentistry
  • Anniston, AL
  • NPI 1568702074
  NPD (past)

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

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1417449349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 1ST AVE SW",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362653329",
            "telephone_number": "256-435-2007",
            "fax_number": "256-435-4669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 1ST AVE SW",
            "city": "JACKSONVILLE",
            "state": "AL",
            "postal_code": "362653329",
            "telephone_number": "256-435-2007",
            "fax_number": "256-435-4669"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "76 County Road 64",
            "address_purpose": "LOCATION",
            "city": "Woodland",
            "state": "AL",
            "postal_code": "362805209",
            "country_code": "US",
            "telephone_number": "256-449-2448",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1695 Golden Springs Rd",
            "address_purpose": "LOCATION",
            "city": "Anniston",
            "state": "AL",
            "postal_code": "362077097",
            "country_code": "US",
            "telephone_number": "256-831-1333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DAKOTA",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-06",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "6493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Dianne Cheatwood, LPN
• City of Jacksonville
• Kyle Andrew Clapper
• Briyana Clark
• Christopher Marvin Clark, ATC
• Julie Clark, PHARMD
• Ashton Clemmons, PTA
• Clinical Urology Associates, P.C.
• CNH, LLC (Shaping Brighter Futures)
• Shanele Kaneisha Cobb

• General Practice Dentistry in Jacksonville, AL
• Providers in Jacksonville, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; 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.