Tanner Ireland Clark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2024019621 Issued in MO

Practice address

319 NE Vivion Rd
Kansas City, MO 64118-4510

Phone

(816) 459-0000

NPI assigned

May 31, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1717113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1699515122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5906 W 57TH ST",
            "city": "MISSION",
            "state": "KS",
            "postal_code": "662021949",
            "telephone_number": "913-293-7527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 NE VIVION RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641184510",
            "telephone_number": "816-459-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TANNER",
        "middle_name": "IRELAND",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-05-31",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2024019621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaley Clark
• Nicholas Clark, M.D.
• Samuel S Clark
• Stephanie Nicole Clark, M.D.
• Tamika Clark, N.P.
• Toby Clark
• Carrie Clarke, M.D.
• Cary L Clarke, MD
• Megan Clarke
• Shereece Shanika Clarke

• General Practice Dentistry in Kansas City, MO
• Providers in Kansas City, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.