Active NPI
Mark Wayne Clark, DDS
- Dentist
- Flint, MI
National Provider Identifier
1447352828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901014278
- Practice address
- G-3550 Flushing Rd
Flint, MI 48504 - Phone
- (810) 732-4370
- Fax
- (810) 732-7564
- NPI assigned
- Sep 5, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2901014278 | MI | Primary |
Addresses
Primary practice location
G-3550 Flushing Rd
Flint, MI 48504
Mailing address
G-3550 Flushing Rd
Flint, MI 48504
Phone (810) 732-4370
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1948222 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150430001518 | MI | Order and Referring Only - Oral Surgery | 5799004487 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447352828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "G-3550 FLUSHING RD",
"city": "FLINT",
"state": "MI",
"postal_code": "48504",
"telephone_number": "810-732-4370",
"fax_number": "810-732-7564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "G-3550 FLUSHING RD",
"city": "FLINT",
"state": "MI",
"postal_code": "48504",
"telephone_number": "810-732-4370",
"fax_number": "810-732-7564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MARK",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901014278",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1948222",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.