Active NPI
Stan Reed Clark, D.M.D
- General Practice Dentistry
- Salt Lake City, UT
National Provider Identifier
1629021969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 5428628-9921
- Practice address
- 160 S 1000 E
Suite 340
Salt Lake City, UT 84102-1428 - Phone
- (801) 355-3065
- NPI assigned
- May 18, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5428628-9921 | UT | Primary |
Addresses
Primary practice location
160 S 1000 E
Suite 340
Salt Lake City, UT 84102-1428
Mailing address
160 S 1000 E
Suite 340
Salt Lake City, UT 84102-1428
Phone (801) 355-3065
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 |
|---|---|---|---|
| 5428628-9921 | UT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204070400000",
"number": "1629021969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 S 1000 E",
"address_2": "SUITE 340",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841021428",
"telephone_number": "801-355-3065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 S 1000 E",
"address_2": "SUITE 340",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841021428",
"telephone_number": "801-355-3065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "STAN",
"middle_name": "REED",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-18",
"last_updated": "2008-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "UT",
"license": "5428628-9921",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.