Active NPI
Misty Dawn Clark, D.M.D.
- Dentist
- Prestonsburg, KY
National Provider Identifier
1780870196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8481
- Practice address
- 83 Oak Ridge CT
Prestonsburg, KY 41653 - Phone
- (606) 886-0300
- NPI assigned
- Sep 19, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8481 | KY | Primary |
Addresses
Primary practice location
83 Oak Ridge CT
Prestonsburg, KY 41653
Mailing address
83 Oak Ridge CT
Prestonsburg, KY 41653
Phone (606) 886-0300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8481 | KY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthy Smiles Family & Cosmetic Dentistry PSC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Prestonsburg, KY
- NPI 1194064493
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247529600000",
"number": "1780870196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "83 OAK RIDGE CT",
"city": "PRESTONSBURG",
"state": "KY",
"postal_code": "41653",
"telephone_number": "606-886-0300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "83 OAK RIDGE CT",
"city": "PRESTONSBURG",
"state": "KY",
"postal_code": "41653",
"telephone_number": "606-886-0300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "MISTY",
"middle_name": "DAWN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-09-19",
"last_updated": "2009-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "8481",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prestonsburg, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.