Clark Oral Surgery and Implant Center

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D10177 Issued in OR

Legal business name

CLARK ORAL SURGERY AND IMPLANT CENTER

Doing business as

Dr. Tyler L. Clark

Practice address

9430 SW Coral St Ste 200
Tigard, OR 97223-6692

Phone

(503) 245-1100

Fax

(503) 473-8300

NPI assigned

Jun 20, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Esther Mastrandrea

Title

Office Manager

Phone

(503) 245-1100

Specialties & licenses 1

Addresses

Other names 1

• Dr. Tyler L. Clark Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dennis P Clark, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Tigard, OR
  • NPI 1386868370
  NPD (past)
• Tyler Lee Clark, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Eugene, OR
  • NPI 1578542361
  NPD (past)

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1598285777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9430 SW CORAL ST STE 200",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236692",
            "telephone_number": "503-245-1100",
            "fax_number": "503-473-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9430 SW CORAL ST STE 200",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972236692",
            "telephone_number": "503-245-1100",
            "fax_number": "503-473-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK ORAL SURGERY AND IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MASTRANDREA",
        "authorized_official_first_name": "ESTHER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-245-1100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OR",
            "license": "D10177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Tyler L. Clark",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chyril Walker PHD PC
• Brent Cichoski, M.A.
• Melissa M Cisneros
• Kristin Suzanne Ciula, RN/BSN
• Susan M Clack, MD
• Blythe Patricia Clark-McKitrick
• Adry Snorradottir Clark, PHD
• Alice Halsey Clark, RN
• Ashley Rose Clark
• Barbara Anne Clark, P.T.

• Dental Clinic/Center in Tigard, OR
• Providers in Tigard, OR by specialty
• Dental Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.