Active NPI
Harry M Clark III
- Dentist
- Malta, NY
National Provider Identifier
1679745129
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Practice address
- 519 State Route 67
Malta, NY 12020-4334 - Phone
- (518) 899-7121
- NPI assigned
- Mar 25, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | NY | Primary |
Addresses
Primary practice location
519 State Route 67
Malta, NY 12020-4334
Mailing address
142 County Route 70
Greenwich, NY 12834-6302
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 |
|---|---|---|---|
| 122300000X | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206403200000",
"number": "1679745129",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "142 COUNTY ROUTE 70",
"city": "GREENWICH",
"state": "NY",
"postal_code": "128346302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "519 STATE ROUTE 67",
"city": "MALTA",
"state": "NY",
"postal_code": "120204334",
"telephone_number": "518-899-7121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK III",
"first_name": "HARRY",
"middle_name": "M",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-25",
"last_updated": "2008-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Malta, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.