Daniel Dee Clark, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD3904 Issued in NM

Practice address

1001 W Broadway
Suite D and E
Farmington, NM 87401-5638

Phone

(505) 325-9133

NPI assigned

Apr 3, 2013

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

Medicare fee-for-service enrollment

Enrolled in NM

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424822400000",
    "number": "1730422106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4104 N BUENA VISTA AVE",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874012374",
            "telephone_number": "214-793-7256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W BROADWAY",
            "address_2": "SUITE D AND E",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015638",
            "telephone_number": "505-325-9133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DANIEL",
        "middle_name": "DEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-03",
        "last_updated": "2015-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD3904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clarence Austin Church III, LMHC
• Clay Church, NP
• Maria L Cisneros, LCSW
• Clarity Counseling P.C.
• Candice Ella Clark, DDS
• Diamond Darlene Clark, RN
• Jeffrey C Clark, D.D.S.
• Stephen B Clark, DDS,MS
• Brett M. Clarke, MD
• Classic Eyewear, Inc

• General Practice Dentistry in Farmington, NM
• Providers in Farmington, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.