NPIMap

Organization Active NPI

Kelly Clark DDS PC

Doing business as Decatur Dental Care

  • General Practice Dentistry
  • Decatur, IL
National Provider Identifier
1982839056
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
060009717 Issued in IL
Legal business name
KELLY CLARK DDS PC
Doing business as
Decatur Dental Care
Practice address
3737 E Route 36
Decatur, IL 62521
Phone
(217) 423-2400
NPI assigned
May 19, 2009
Last updated
Jun 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

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

Authorized official

Name
Dr. Kelly Clark, DDSNPI 1942379458
Title
Doctor Owner
Phone
(217) 423-2400

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
General Practice Dentistry 1223G0001X 060009717 IL Primary

Addresses

Primary practice location

3737 E Route 36
Decatur, IL 62521

Mailing address

3737 E Route 36
Decatur, IL 62521
Phone (217) 423-2400

Other identifiers 4

IdentifierTypeStateIssuer
1801059100OtherILBLUE CROSS
1942379458OtherILBLUE CROSS
1700959020OtherILBLUE CROSS
1073693883OtherILBLUE CROSS

Other names 1

  • Decatur Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

3737 E US Route 36
Decatur, IL 62521
Phone (217) 423-2400

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780963200000",
    "number": "1982839056",
    "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 ROUTE 36",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "62521",
            "telephone_number": "217-423-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY CLARK DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-19",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DOCTOR OWNER",
        "authorized_official_telephone_number": "217-423-2400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "060009717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1801059100",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1942379458",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1700959020",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1073693883",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Decatur Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; 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.