Clark Family Dental Inc

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6137015 Issued in WI

Legal business name

CLARK FAMILY DENTAL INC

Doing business as

Park Avenue Dental

Practice address

777 Park Avenue
Chippewa Falls, WI 54729

Phone

(715) 723-0367

NPI assigned

Jan 9, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey Michael Clark, DMD

Title

Dentist

Phone

(715) 723-0367

Specialties & licenses 1

Addresses

Other names 1

• Park Avenue Dental Doing business as

Locations

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

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231459200000",
    "number": "1689811853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 PARK AVENUE",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "54729",
            "telephone_number": "715-723-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 PARK AVENUE",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "54729",
            "telephone_number": "715-723-0367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK FAMILY DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-09",
        "last_updated": "2009-01-09",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "715-723-0367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6137015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Avenue Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sirin Chundu, DDS
• Desiree Ciokiewicz, SAC
• Halie Marie Ciokiewicz, DNP, APNP, FNP-C
• City of Chippewa Falls
• City of Chippewa Falls Fire & Emergency Services
• Ronald Clutter, D.C.
• Monique Collette
• Connection Therapy & Wellness, LLC (Connection Therapy & Wellness)
• Brooke Joanne Connor, SLP
• Cook Chiropractic

• General Practice Dentistry in Chippewa Falls, WI
• Providers in Chippewa Falls, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2009; 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.