NPIMap

Organization Active NPI

Carrollwood Dental Group LLC

  • General Practice Dentistry
  • Bridgeton, MO
National Provider Identifier
1821216060
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2003012113 Issued in MO
Legal business name
CARROLLWOOD DENTAL GROUP LLC
Practice address
12147 Natural Bridge Rd
Bridgeton, MO 63044-2018
Phone
(314) 739-3700
Fax
(314) 739-5048
NPI assigned
Apr 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Victor L Clark, D.M.D.
Title
Owner
Phone
(314) 739-3700

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 14202 MO
General Practice Dentistry 1223G0001X 2003012113 MO Primary
General Practice Dentistry 1223G0001X 013326 MO

Addresses

Primary practice location

12147 Natural Bridge Rd
Bridgeton, MO 63044-2018

Mailing address

12147 Natural Bridge Rd
Bridgeton, MO 63044-2018
Phone (314) 739-3700

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821216060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12147 NATURAL BRIDGE RD",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442018",
            "telephone_number": "314-739-3700",
            "fax_number": "314-739-5048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12147 NATURAL BRIDGE RD",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442018",
            "telephone_number": "314-739-3700",
            "fax_number": "314-739-5048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARROLLWOOD DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-739-3700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "14202",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2003012113",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "013326",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.