NPIMap

Organization Active NPI

Clark Orthodontics, Inc.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • North Liberty, IA
National Provider Identifier
1891083002
Registry record updated Jan 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
08218 Issued in IA
Legal business name
CLARK ORTHODONTICS, INC.
Practice address
650 W. Cherry St.
Suite 5
North Liberty, IA 52317
Phone
(319) 626-3161
NPI assigned
Jul 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2012

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

Authorized official

Name
Tanner ClarkNPI 1790734796
Title
President
Phone
(319) 626-3161

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 08218 IA Primary

Addresses

Primary practice location

650 W. Cherry St.
Suite 5
North Liberty, IA 52317

Mailing address

650 W. Cherry St.
Suite 5
North Liberty, IA 52317
Phone (319) 626-3161

National Provider Directory

National Provider Directory

Locations

650 W Cherry St
Ste 5
North Liberty, IA 52317
Phone (319) 626-3161

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327622400000",
    "number": "1891083002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 W. CHERRY ST.",
            "address_2": "SUITE 5",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "52317",
            "telephone_number": "319-626-3161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W. CHERRY ST.",
            "address_2": "SUITE 5",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "52317",
            "telephone_number": "319-626-3161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK ORTHODONTICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-21",
        "last_updated": "2012-01-27",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TANNER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "319-626-3161"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IA",
            "license": "08218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Liberty, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2012; 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.