Roy George Clark, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7225 Issued in FL

Practice address

5720 5TH Ave N
Saint Petersburg, FL 33710-7104

Phone

(727) 345-0489

NPI assigned

Jun 12, 2007

Sex

Male

Sole proprietor

Yes

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

Enrolled in FL

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

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

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450828800000",
    "number": "1881898005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5720 5TH N AVE",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337107104",
            "telephone_number": "727-345-0489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5720 5TH AVE N",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337107104",
            "telephone_number": "727-345-0489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "ROY",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2015-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "7225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Michael Clark, RPH
• Jonathan Andrew Clark, APRN
• Karen Yvette Clark, M.S.
• Kenneth John Clark Jr., DPT
• Masharia Ann Clark, ARNP
• Thomas G. Clark, D.C.
• Victoria Isabelle Clark, LMHC
• Carolyn Marie Clarke, ARNP
• Henry Bushnell Clarke, M.D.
• Kelly R Clarke, DDS

• General Practice Dentistry in Saint Petersburg, FL
• Providers in Saint Petersburg, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; 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.