Active NPI
Cody Clark, DDS
- Dentist
- Camp Lejeune, NC
National Provider Identifier
1831732825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11134
- Practice address
- 700 McHugh Blvd
Camp Lejeune, NC 28540 - Phone
- (910) 451-6122
- NPI assigned
- Oct 22, 2019
- Sex
- Male
- Sole proprietor
- No
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 | 11134 | TN | Primary |
Addresses
Primary practice location
700 McHugh Blvd
Camp Lejeune, NC 28540
Mailing address
214 Newport Dr
Jacksonville, NC 28540-4005
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13006 | NC | MD | Speech-Language Pathologist |
| 11134 | TN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698192000000",
"number": "1831732825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "214 NEWPORT DR",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285404005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 MCHUGH BLVD",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "28540",
"telephone_number": "910-451-6122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CODY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-22",
"last_updated": "2023-10-25",
"certification_date": "2023-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "11134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camp Lejeune, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.