NPIMap

Organization Active NPI

Shelly K. Clark, Dentistry for Children

  • Pediatric Dentistry
  • Midlothian, TX
National Provider Identifier
1821684929
Registry record updated Dec 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SHELLY K. CLARK, DENTISTRY FOR CHILDREN
Practice address
4450 E Highway 287
Midlothian, TX 76065-5576
Phone
(972) 723-0111
NPI assigned
Dec 14, 2020
Organization subpart
Yes
Parent organization
SHELLY K. CLARK, DENTISTRY FOR CHILDRENAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 14, 2020

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

Authorized official

Name
Dr. Shelly Clark, DDSNPI 1891880076
Title
Owner
Phone
(972) 291-4281

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

4450 E Highway 287
Midlothian, TX 76065-5576

Mailing address

4450 E Highway 287
Midlothian, TX 76065-5576
Phone (972) 723-0111

Other identifiers 1

IdentifierTypeStateIssuer
210909202MedicaidTX

Other names 1

  • Shelly K. Clark, DDS Dentistry for Children Doing business as

National Provider Directory

National Provider Directory
Part of
Shelly K Clark Dentistry for Children

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1607904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607904000000",
    "number": "1821684929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4450 E HIGHWAY 287",
            "city": "MIDLOTHIAN",
            "state": "TX",
            "postal_code": "760655576",
            "telephone_number": "972-723-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4450 E HIGHWAY 287",
            "city": "MIDLOTHIAN",
            "state": "TX",
            "postal_code": "760655576",
            "telephone_number": "972-723-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELLY K. CLARK, DENTISTRY FOR CHILDREN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHELLY K. CLARK, DENTISTRY FOR CHILDREN",
        "enumeration_date": "2020-12-14",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-291-4281",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210909202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shelly K. Clark, DDS Dentistry for Children",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Midlothian, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.