John Nicholas Clark, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

3810 Issued in AR

Practice address

810 Locust St
Conway, AR 72034-5331

Phone

(479) 466-3834

NPI assigned

Jul 27, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349049600000",
    "number": "1649401597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 LOCUST ST",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720345331",
            "telephone_number": "479-466-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 LOCUST ST",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720345331",
            "telephone_number": "479-466-3834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JOHN",
        "middle_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-27",
        "last_updated": "2012-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "3810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187121608",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Drury Clark, CF-SLP
• Edgel Clark, RECOVERY ASSISTANT
• Emmett Don Clark Jr., PTA
• James T Clark Jr., M.D.
• Jaymond Ryan Clark, DC
• Kelly L Clark, PTA
• Leslea Clark, M.S.CCC-SLP
• Madelyn Clark
• Mark L Clark, PHD
• Raymond H Clark, MD

• Dentist in Conway, AR
• Providers in Conway, AR by specialty
• Dentist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.