Daniel John Clark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30018843 Issued in OH

Practice address

624 S High St
Hillsboro, OH 45133

Phone

(937) 393-3494

Fax

(937) 393-6864

NPI assigned

Aug 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Daniel J. Clark, DDS, Inc.

  • Dentist
  • Hillsboro, OH
  • NPI 1144228875
  NPD (past) Authorized official

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851308472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 S HIGH ST",
            "city": "HILLSBORO",
            "state": "OH",
            "postal_code": "45133",
            "telephone_number": "937-393-3494",
            "fax_number": "937-393-6864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 S HIGH ST",
            "city": "HILLSBORO",
            "state": "OH",
            "postal_code": "45133",
            "telephone_number": "937-393-3494",
            "fax_number": "937-393-6864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DANIEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30018843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPERIOR",
            "identifier": "120090",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "782967",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0748132",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roger Cheesbro, LPCC-S, LICDC-CS
• Niti Nilay Chokshi
• Jenny Lynn Christman, LMT
• Cincinnati Lab Med Asoc.
• City of Hillsboro
• Alana Clemons
• Torie Clemons
• April D Clift
• Shiela A Clouser, SWA
• Timothy L Clouser

• General Practice Dentistry in Hillsboro, OH
• Providers in Hillsboro, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.