David Matthew Clark, DDS
Individual provider Active NPI General Practice Dentistry · Holladay, UT
NPI 1902193253 · NPPES record last updated Jul 7, 2011
Key facts
- NPI
- 1902193253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 5606768-9922 (UT)
- Practice address
- 2180 E 4500 S
Suite 250
Holladay, UT 84117-4434 - Phone
- (801) 272-8609
- NPI assigned
- Jul 7, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150611003349 | UT | Order and Referring Only - Dentist |
0648591933 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smart Dental Care | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5606768-9922 | UT | Yes |
Addresses
Primary practice location
2180 E 4500 S
Suite 250
Holladay, UT 84117-4434
Mailing address
2180 E 4500 S
Suite 250
Holladay, UT 84117-4434
Phone (801) 272-8609
Other providers in Holladay, UT
- Matthew Chaus
- Karl Chen
- David L Christensen
- Katie Lynn Christensen
- Judy Huynh Chung
- Jayne Elizabeth Clark
- Jennifer Stewart Clark
- CNM
- Ronald T Cohn
- Rebecca L Conde
All providers in Holladay, UT · General Practice Dentistry in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.