Dr. Johhny M Clark DDS PC

Primary specialty

DentistTaxonomy code 122300000X

License

12810 Issued in TX

Legal business name

DR. JOHHNY M CLARK DDS PC

Practice address

121 N Rice St
Hamilton, TX 76531-1857

Phone

(254) 386-8957

Fax

(254) 386-3240

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Lynda Marliessa Clark

Title

Office Manager

Phone

(254) 784-0508

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1831200427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21",
            "city": "ENERGY",
            "state": "TX",
            "postal_code": "764520021",
            "telephone_number": "254-784-0508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N RICE ST",
            "city": "HAMILTON",
            "state": "TX",
            "postal_code": "765311857",
            "telephone_number": "254-386-8957",
            "fax_number": "254-386-3240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. JOHHNY M CLARK DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_middle_name": "MARLIESSA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "254-784-0508"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "12810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "090274402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Hamilton, TX
• Providers in Hamilton, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; 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.