NPIMap

Organization Active NPI

Dr. Albert Clark DDS, PC

  • Dentist
  • Provo, UT
National Provider Identifier
1972772853
Registry record updated Feb 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
139191-9922 Issued in UT
Legal business name
DR. ALBERT CLARK DDS, PC
Practice address
1355 N University Ave
Suite 320
Provo, UT 84604-2721
Phone
(801) 375-1750
Fax
(801) 375-6365
NPI assigned
Feb 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2008

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

Authorized official

Name
Dr. Albert Baxter Clark, DDSNPI 1477571677
Title
President
Phone
(801) 375-1750

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 139191-9922 UT Primary

Addresses

Primary practice location

1355 N University Ave
Suite 320
Provo, UT 84604-2721

Mailing address

1355 N University Ave
Suite 320
Provo, UT 84604-2721
Phone (801) 375-1750

National Provider Directory

National Provider Directory

Locations

1355 N University Ave
Ste 320
Provo, UT 84604
Phone (801) 375-1750

Practitioners & affiliated clinicians

Practitioners 3

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": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203984000000",
    "number": "1972772853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 N UNIVERSITY AVE",
            "address_2": "SUITE 320",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846042721",
            "telephone_number": "801-375-1750",
            "fax_number": "801-375-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 N UNIVERSITY AVE",
            "address_2": "SUITE 320",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846042721",
            "telephone_number": "801-375-1750",
            "fax_number": "801-375-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. ALBERT CLARK DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2008-02-26",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "BAXTER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-375-1750",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "139191-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; 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.