Clark & Otero DDS PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CLARK & OTERO DDS PLLC

Doing business as

Oak Grove Dental

Practice address

103 Ganyard Farm Way
Durham, NC 27703-6230

Phone

(919) 957-2444

Fax

(888) 505-9592

NPI assigned

Dec 3, 2014

Organization subpart

No

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

Authorized official

Name

Bebe Gunter Jackson

Title

Manager

Phone

(910) 863-2377

Specialties & licenses 3

Addresses

Other names 1

• Oak Grove Dental Doing business as

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1710384938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 GANYARD FARM WAY",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "27703",
            "telephone_number": "919-597-2444",
            "fax_number": "888-505-9592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 GANYARD FARM WAY",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277036230",
            "telephone_number": "919-957-2444",
            "fax_number": "888-505-9592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK & OTERO DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BEBE",
        "authorized_official_middle_name": "GUNTER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "910-863-2377"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "9387",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oak Grove Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Clara P Davis, DDS, PLLC
• Clare a. Stadlen, LCSW, PLLC
• Glenda Clare, LCMHC, LPC
• Suzanne Clare, DC
• Clarity Co Counseling, PLLC
• Clark & Otero DDS PLLC (Dental Center at Zebulon)
• Clark Optometric Center PA (Triangle Visions Optometry)
• Clark Psychotherapy, PLLC
• Adrian Joseph Clark-Randall, MD
• Celia P Clark-Randall, IBCLC

• General Practice Dentistry in Durham, NC
• Providers in Durham, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.