Allison Clark, D.D.S.

Key facts

NPI

1629429592

Entity type

Individual (NPI type 1)

Primary specialty

Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X

License

22DI02646800 (NJ)

Practice address

109 Kings Hwy W
Haddonfield, NJ 08033-2127

Phone

(856) 428-1444

NPI assigned

Jun 22, 2016

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

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.

• Earl B Broker DDS LLC Dentist · Voorhees, NJ · NPI 1659451821
  NPD (past) SINGLE SPECIALTY

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 23, 2024.

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727049600000",
    "number": "1629429592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 KINGS HWY W",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080332127",
            "telephone_number": "856-428-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 KINGS HWY W",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080332127",
            "telephone_number": "856-428-1444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "992 Mantua Pike Ste 203",
            "address_purpose": "LOCATION",
            "city": "Woodbury Heights",
            "state": "NJ",
            "postal_code": "080971249",
            "country_code": "US",
            "telephone_number": "856-845-1144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2301 E Evesham Rd Ste 301",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080434503",
            "country_code": "US",
            "telephone_number": "856-770-9200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ALLISON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-22",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NJ",
            "license": "22DI02646800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Haddonfield, NJ · Orthodontics and Dentofacial Orthopedics Dentistry in New Jersey