Anthony Clark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS102890 Issued in CA

Practice address

4129 S Mooney Blvd Ste B
Visalia, CA 93277-9147

Phone

(559) 732-1953

NPI assigned

Aug 10, 2018

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

State licenses

Practice roles

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.

• Fareid Dental Corporation

  dba Packwood Creek Dental Group

  • General Practice Dentistry
  • Visalia, CA
  • NPI 1265839831
  NPD (past)

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

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533859200000",
    "number": "1467931352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2159 BELLA OAKS DR",
            "city": "TULARE",
            "state": "CA",
            "postal_code": "932747760",
            "telephone_number": "559-495-8085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4129 S MOONEY BLVD STE B",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932779147",
            "telephone_number": "559-732-1953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-10",
        "last_updated": "2018-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS102890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA DENTAL LICENSE",
            "identifier": "DDS102890",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Henry Camilo Cisneros Jr., DDS
• Aziza Citi
• City of Visalia - Fire Department
• Gurpreet Kaur Clair, FNP
• Alyssa Nicole Clark
• Taralyn Clausen, FNP
• Jessica Clavijo
• Kelly C Cleaver, ATC
• Pamela L. Cliburn, LVN
• Clifford a Fukushima OD Inc (Integrated Vision Care Optometry)

• General Practice Dentistry in Visalia, CA
• Providers in Visalia, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2018; 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.