Clark O Taylor, M.D.,D.D.S.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

7822 Issued in MT

Practice address

805 S Reserve St
Missoula, MT 59801-2104

Phone

(406) 549-6600

NPI assigned

Nov 10, 2006

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 20, 2017 through Mar 20, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Facial Plastic and Reconstructive Surgery Montana PC

  • Clinic/Center
  • Missoula, MT
  • NPI 1407116338
  NPD
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323

  Oral & Maxillofacial Surgery

  NPD (past)

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301443200000",
    "number": "1689745804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 S RESERVE ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598012104",
            "telephone_number": "406-549-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 S RESERVE ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598012104",
            "telephone_number": "406-549-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "CLARK",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "M.D.,D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-10",
        "last_updated": "2011-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MT",
            "license": "7822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689745804",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jodine Tarbert
• Weston Tardy, MD
• Target Range Elementary School
• Evelyn Mason Tate, DPT
• Abbey Tavares, RN
• Connie J Taylor
• Danielle Taylor
• Jon Mark Taylor, P.T.
• Marielise Taylor
• Natalie Taylor

• Oral & Maxillofacial Surgery (D.M.D.) in Missoula, MT
• Providers in Missoula, MT by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2011; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.