Kelly Clark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019026315 Issued in IL

Practice address

3737 E Rte 36
Decatur, IL 62521-5028

Phone

(217) 423-2400

Fax

(217) 423-2460

NPI assigned

Nov 7, 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

Enrolled in IL

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

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.

• Kelly Clark DDS PC

  • General Practice Dentistry
  • Decatur, IL
  • NPI 1982839056
  NPD (past) Authorized official

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781481600000",
    "number": "1942379458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 E ROUTE 36",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "62521",
            "telephone_number": "217-423-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 E RTE 36",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625215028",
            "telephone_number": "217-423-2400",
            "fax_number": "217-423-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breanne Joleen Clair, MS, CCC-SLP
• Clark Enterprises 407 LLC
• Clark Enterprises 407 LLC
• Amber Teresa Clark, LCSW
• Hailee Clark
• Mark C Clarke, MD
• Ben Clawson, ATC, CSCS
• Shelbi Clay, LPN
• Lilian Kay Clayton, CNM
• Amanda Clemons, RBT

• General Practice Dentistry in Decatur, IL
• Providers in Decatur, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; 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.