Active NPI
Anne Campbell Clark, DDS
- Pediatric Dentistry
- Indianapolis, IN
National Provider Identifier
1972289759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 1972289759
- Practice address
- 575 Riley Hospital Dr Suite 4205
Indianapolis, IN 46202 - Phone
- (317) 944-9604
- NPI assigned
- Jun 26, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 1972289759 | IN | Primary |
Addresses
Primary practice location
575 Riley Hospital Dr Suite 4205
Indianapolis, IN 46202
Mailing address
575 Riley Hospital Dr Suite 4205
Indianapolis, IN 46202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231222000991 | IN | Order and Referring Only - Dentist | 7315397932 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1972289759 | IN | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752710400000",
"number": "1972289759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "575 RILEY HOSPITAL DR SUITE 4205",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "46202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "575 RILEY HOSPITAL DR SUITE 4205",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "46202",
"telephone_number": "317-944-9604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ANNE",
"middle_name": "CAMPBELL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-26",
"last_updated": "2025-07-17",
"certification_date": "2025-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IN",
"license": "1972289759",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2025; 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.