H Clark Sturdivant, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7974 Issued in WA

Practice address

608 Polk St
Port Townsend, WA 98368-6532

Phone

(360) 385-0567

NPI assigned

May 17, 2006

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 12, 2017 through Jun 12, 2027

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.

• H. Clark Sturdivant, D.D.S.

  • Dental Clinic/Center
  • Port Townsend, WA
  • NPI 1568815579
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290384000000",
    "number": "1629020649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 POLK ST",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983686532",
            "telephone_number": "360-385-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 POLK ST",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983686532",
            "telephone_number": "360-385-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STURDIVANT",
        "first_name": "H",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2010-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "7974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Strait Orthopedic Specialists
• Strait Orthopedic Specialists
• Pamela Bolin Street, PH.D. MSW LMHC
• Piper Adele Struemph, RN
• Edward Clark Sturdivant, DDS
• Jason J Suh, MD
• Samuel Swenson
• Bruce John Tapper, PH.D
• Aaron Joseph Taylor, PT
• Meagan Stephanie Taylor, RDH

• General Practice Dentistry in Port Townsend, WA
• Providers in Port Townsend, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.