Clark Oral & Facial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

CLARK ORAL & FACIAL SURGERY

Doing business as

Clark Oral & Facial Surgery

Practice address

1502 Locust St N Ste 103
Twin Falls, ID 83301-6375

Phone

(208) 831-2900

NPI assigned

Jan 8, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Paul Clark III, DMD, MDNPI 1689994923

Title

Surgeon, Owner

Phone

(503) 927-6845

Specialties & licenses 1

Addresses

Other names 1

• Clark Oral & Facial Surgery Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Paul Kenneth Clark III, D.M.D, M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Twin Falls, ID
  • NPI 1689994923
  NPD Authorized official

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

{
    "created_epoch": "1704672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1649040858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 LOCUST ST N STE 103",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016375",
            "telephone_number": "208-831-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 LOCUST ST N STE 103",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016375",
            "telephone_number": "208-831-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK ORAL & FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-08",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "SURGEON, OWNER",
        "authorized_official_telephone_number": "503-927-6845",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark Oral & Facial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alyson R Christianson, LMSW
• Christine J Chugg, LCSW
• Cierra Therapy LLC
• Brytany Claasen
• Tracy Jo Clair
• Cameron Talmage Clark, PA-C
• Paul Kenneth Clark III, D.M.D, M.D.
• Peter Boyce Clark
• Rand J. Clark, P.T.
• Timothy Ross Clark, PTA

• Oral and Maxillofacial Surgery (Dentist) in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Oral and Maxillofacial Surgery (Dentist) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.