Active NPI
Laurie Kathleen Clark, RDH
- Dental Hygienist
- Chandler, AZ
National Provider Identifier
1619382082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- H01509
- Practice address
- 777 E Galveston St
Chandler, AZ 85225-8273 - Phone
- (480) 812-7900
- NPI assigned
- Jun 24, 2014
- Last updated
- Jun 24, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | H01509 | AZ | Primary |
Addresses
Primary practice location
777 E Galveston St
Chandler, AZ 85225-8273
Mailing address
14000 N 94TH St Unit 2176
Scottsdale, AZ 85260-7792
Phone (602) 909-0587
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H01509 | AZ | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403568000000",
"number": "1619382082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14000 N 94TH ST UNIT 2176",
"city": "SCOTTSDALE",
"state": "AZ",
"postal_code": "852607792",
"telephone_number": "602-909-0587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 E GALVESTON ST",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852258273",
"telephone_number": "480-812-7900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LAURIE",
"middle_name": "KATHLEEN",
"credential": "RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-24",
"last_updated": "2014-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "AZ",
"license": "H01509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chandler, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.