NPIMap

Organization Active NPI

Sunrise Dental Group PC

  • Dentist
  • Farmington, NM
National Provider Identifier
1447638218
Registry record updated May 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2673 Issued in NM
Legal business name
SUNRISE DENTAL GROUP PC
Doing business as
Clark Family Dentistry
Practice address
141 W 20TH St
Farmington, NM 87401-3401
Phone
(505) 325-7121
NPI assigned
May 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2015

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

Authorized official

Name
Dr. Candice Ella Clark, DDSNPI 1124018379
Title
Owner/Vice President
Phone
(505) 325-7121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 2673 NM Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

141 W 20TH St
Farmington, NM 87401-3401

Mailing address

141 W 20TH St
Farmington, NM 87401-3401
Phone (505) 325-7121

Other names 1

  • Clark Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

141 W 20th St
Farmington, NM 87401
Phone (505) 325-7121

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431475200000",
    "number": "1447638218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 W 20TH ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874013401",
            "telephone_number": "505-325-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 W 20TH ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874013401",
            "telephone_number": "505-325-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNRISE DENTAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-13",
        "last_updated": "2015-05-13",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_middle_name": "ELLA",
        "authorized_official_title_or_position": "OWNER/VICE PRESIDENT",
        "authorized_official_telephone_number": "505-325-7121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "2673",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.