Clark Michael Comeaux, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

3666 Issued in LA

Practice address

BLDG 38717 38TH Street,
USA Dentac,
Fort Gordon, GA 30905-5660

Phone

(706) 787-1070

NPI assigned

Mar 24, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431388800000",
    "number": "1861452757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BLDG 38717 38TH STREET,",
            "address_2": "USA DENTAC",
            "city": "FT GORDON",
            "state": "GA",
            "postal_code": "309055660",
            "telephone_number": "706-787-1070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 38717 38TH STREET,",
            "address_2": "USA DENTAC,",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055660",
            "telephone_number": "706-787-1070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COMEAUX",
        "first_name": "CLARK",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2015-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "LA",
            "license": "3666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Cleveland
• Wallace D Cleveland Jr., PA-C
• Sharon Lynne Cody Greer, D.O.
• Gregory Bryant Coleman
• Latonya Collins, RN, BSN-MSM
• Christian Clarke Conlon, MD
• Ramon Contreras, PT, DPT
• Ronald Gene Cook, DPH
• Randolph D Cooke, PH.D.
• Nathanial Kelsey Copeland, MD, MTM&H

• Oral and Maxillofacial Surgery (Dentist) in Fort Gordon, GA
• Providers in Fort Gordon, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; 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.