Shelly K. Clark

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

18113 Issued in TX

Legal business name

SHELLY K. CLARK

Practice address

211 W Belt Line Rd
Cedar Hill, TX 75104-2066

Phone

(972) 291-0111

Fax

(972) 291-0315

NPI assigned

Mar 16, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Shelly K. Clark, DDS

Title

Owner

Phone

(972) 291-0111

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331856000000",
    "number": "1831464387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 W BELT LINE RD",
            "city": "CEDAR HILL",
            "state": "TX",
            "postal_code": "751042066",
            "telephone_number": "972-291-0111",
            "fax_number": "972-291-0315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 W BELT LINE RD",
            "city": "CEDAR HILL",
            "state": "TX",
            "postal_code": "751042066",
            "telephone_number": "972-291-0111",
            "fax_number": "972-291-0315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELLY K. CLARK",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-16",
        "last_updated": "2012-03-16",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-291-0111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "18113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891880076",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolyn Homan Shannon, LPC
• Donna Arlene Shannon, M.D.
• Share Wellness Medical Clinic PLLC
• Kyra Shaw, DPT, ATC
• Paul V Shelburne, MD
• Shelly K. Clark D.D.S., P.a.
• Imisha Nikole Shelton
• Sheri Ekukpe D.C.P.a.
• Sherry L. Bowers, DPM, PA
• Shining Star Residential Facility, LLC.

• Pediatric Dentistry in Cedar Hill, TX
• Providers in Cedar Hill, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; 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.