Martin James Clark, DDS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

10468 Issued in TX

Practice address

4185 Technology Forest Blvd
Suite 100
The Woodlands, TX 77381-2006

Phone

(281) 296-9562

Fax

(281) 296-9774

NPI assigned

Jun 24, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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 Jun 18, 2013 through Jun 18, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450396800000",
    "number": "1447256367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4185 TECHNOLOGY FOREST BLVD",
            "address_2": "SUITE 120",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773812006",
            "telephone_number": "281-296-9562",
            "fax_number": "281-296-9774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4185 TECHNOLOGY FOREST BLVD",
            "address_2": "SUITE 100",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773812006",
            "telephone_number": "281-296-9562",
            "fax_number": "281-296-9774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MARTIN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-24",
        "last_updated": "2015-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "TX",
            "license": "10468",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "10468",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destiny Eileen Cisco
• CJ Soloman DDS PA
• Clarity Therapy Mental Wellness
• Champ Michael Clark, D.P.T, PT, CSCS
• Kenneth Dale Clark
• Elizabeth F Clarke, CCC-SLP
• Judith Elinor Clarke, PT
• Tori Claros, MT-BC
• Kendall Nicole Clayton, MD
• Cleartone Hearing Aid Centers Inc

• Oral & Maxillofacial Surgery (D.M.D.) in The Woodlands, TX
• Providers in The Woodlands, TX by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; 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.