Michael Kenneth Clark, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

41907 Issued in CA

Practice address

27725 Santa Margarita Pkwy
Suite 130
Mission Viejo, CA 92691-6704

Phone

(949) 470-3672

Fax

(949) 472-2095

NPI assigned

Jun 14, 2013

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Foothill Oral Surgery Center

  • Oral and Maxillofacial Surgery (Dentist)
  • Mission Viejo, CA
  • NPI 1629282355
  NPD (past)

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

{
    "created_epoch": "1371168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371168000000",
    "number": "1619316403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27725 SANTA MARGARITA PKWY",
            "address_2": "SUITE 130",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916704",
            "telephone_number": "949-470-3672",
            "fax_number": "949-472-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27725 SANTA MARGARITA PKWY",
            "address_2": "SUITE 130",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916704",
            "telephone_number": "949-470-3672",
            "fax_number": "949-472-2095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHAEL",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-14",
        "last_updated": "2013-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "41907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Talya Danielle Cisneros, PT, DPT
• Clarity California Psychological Services, Inc
• Chelsea Clark
• Diane Faith Clark, LEP 3014
• Janny N. Clark, NP
• Edione Clarke
• Rosemary Ann Clarke, RNFA
• Richard James Claveria, M.D.
• Jon Christopher Clements
• Linda Lee Cleveland-O'Keefe, M.S.

• Oral and Maxillofacial Surgery (Dentist) in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; 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.