NPIMap

Organization Active NPI

Clark Dental a Professional Dental Corporation

Doing business as Clark Dental General and Cosmetic dentistry

  • General Practice Dentistry
  • El Dorado Hills, CA
National Provider Identifier
1508136748
Registry record updated Jan 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
57075 Issued in CA
Legal business name
CLARK DENTAL A PROFESSIONAL DENTAL CORPORATION
Doing business as
Clark Dental General and Cosmetic dentistry
Practice address
4420 Town Center Blvd
280
El Dorado Hills, CA 95762-7134
Phone
(916) 251-6810
NPI assigned
Jan 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2012

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

Authorized official

Name
Dr. Reuben J Clark, DDSNPI 1013177062
Title
Ceo
Phone
(916) 251-6810

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 57075 CA Primary

Addresses

Primary practice location

4420 Town Center Blvd
280
El Dorado Hills, CA 95762-7134

Mailing address

4420 Town Center Blvd
280
El Dorado Hills, CA 95762-7134
Phone (916) 251-6810

Other names 1

  • Clark Dental General and Cosmetic dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

4420 Town Center Blvd
Ste 280
El Dorado Hills, CA 95762
Phone (916) 251-6810

Practitioners & affiliated clinicians

Practitioners 1

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": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325721600000",
    "number": "1508136748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4420 TOWN CENTER BLVD",
            "address_2": "280",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957627134",
            "telephone_number": "916-251-6810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 TOWN CENTER BLVD",
            "address_2": "280",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957627134",
            "telephone_number": "916-251-6810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK DENTAL A PROFESSIONAL DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2012-01-05",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "REUBEN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-251-6810",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "57075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark Dental General and Cosmetic dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Dorado Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; 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.