David Allen Clark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60023580 Issued in WA

Practice address

4209 Tieton Dr
Suite 102
Yakima, WA 98908-3377

Phone

(509) 966-2230

NPI assigned

Aug 6, 2008

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 WA

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

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318550400000",
    "number": "1962668202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4209 TIETON DR",
            "address_2": "SUITE 102",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083377",
            "telephone_number": "509-966-2230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4209 TIETON DR",
            "address_2": "SUITE 102",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083377",
            "telephone_number": "509-966-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DAVID",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-06",
        "last_updated": "2011-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60023580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Elizabeth Clark-Boucher, CPM, LM
• Caroline Clark, ARNP
• Christopher J Clark, DO
• Christopher J Clark, MED
• Cindy L Clark
• Heather Clark
• Holly Clark, PHARMD
• Jeffrey Scott Clark, LMHC
• Jenatte Virginia Clark, ARNP
• Leah Eve Clark, LMT

• General Practice Dentistry in Yakima, WA
• Providers in Yakima, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; 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.