Kendra Nicole Clark, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

34365 Issued in TX

Practice address

3880 Hulen St Ste 310
Fort Worth, TX 76107-7274

Phone

(817) 737-7668

NPI assigned

Jan 4, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Essential Endodontics PA

  • Endodontics
  • Fort Worth, TX
  • NPI 1831756576
  NPD (past)

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

{
    "created_epoch": "1578096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1831738087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 MARILLA ST APT 4310",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752015959",
            "telephone_number": "601-213-4389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3880 HULEN ST STE 310",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077274",
            "telephone_number": "817-737-7668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2650 Beach Blvd",
            "address_purpose": "LOCATION",
            "city": "Biloxi",
            "state": "MS",
            "postal_code": "395314517",
            "country_code": "US",
            "telephone_number": "228-207-1581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KENDRA",
        "middle_name": "NICOLE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-04",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "34365",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3992-18",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MS",
            "license": "3992-18",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "TX",
            "license": "34365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Clark
• Jessie D Clark
• Joann Clark, RN
• Katherine Anne Clark, DDS
• Keely Clark, RNFA
• Lauren Clark, LMT
• Lisamarie Helen Clark, OD
• Megan H Clark, S.L.P.
• Sandra Clark, LPC ASSOCIATE
• Sharon Ellen Clark, DO MPH

• Endodontics in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Endodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.