David Michael Clark, D.M.D

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DA 026947 A Issued in PA

Practice address

799 Northern Blvd
South Abington Township, PA 18411-9087

Phone

(570) 586-1700

Fax

(570) 586-1900

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Warren Dental Arts, Inc

  • General Practice Dentistry
  • Warren, PA
  • NPI 1821037235
  NPD (past) Authorized official

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452124800000",
    "number": "1619919685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "799 NORTHERN BLVD",
            "city": "SOUTH ABINGTON TOWNSHIP",
            "state": "PA",
            "postal_code": "184119087",
            "telephone_number": "570-586-1700",
            "fax_number": "570-586-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "799 NORTHERN BLVD",
            "city": "SOUTH ABINGTON TOWNSHIP",
            "state": "PA",
            "postal_code": "184119087",
            "telephone_number": "570-586-1700",
            "fax_number": "570-586-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DAVID",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2016-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DA 026947 A",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS 026947 L",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "046057-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1476589",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Desiree Lynn Carlin, COTA/L
• Lisa Marie Carson, RPH
• Mark R Chapman
• Chinchilla Hose Company of South Abington Township
• Mackenzie Cigarski-Sutton
• Jessica Clark, MRP
• Natasha Jael Cline, FNP-C
• Amy Beth Cravath, DMD
• Crossroads Counseling and Wellness LLC
• Crossroads Recovery Counseling LLC

• Oral and Maxillofacial Surgery (Dentist) in South Abington Township, PA
• Providers in South Abington Township, PA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2016; 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.