John Nicholas Clark D.D.S., PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3810 Issued in AR

Legal business name

JOHN NICHOLAS CLARK D.D.S., PA

Practice address

810 Locust St
Conway, AR 72034-5331

Phone

(501) 327-4589

NPI assigned

Oct 1, 2012

Last updated

Oct 1, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John Nicholas Clark, D.D.S.NPI 1649401597

Title

President

Phone

(479) 466-3834

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• John Nicholas Clark, D.D.S.

  • Dentist
  • Conway, AR
  • NPI 1649401597
  Authorized official Same address or phone

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349049600000",
    "number": "1992056998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 LOCUST ST",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720345331",
            "telephone_number": "501-327-4589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 LOCUST ST",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720345331",
            "telephone_number": "501-327-4589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN NICHOLAS CLARK D.D.S., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-01",
        "last_updated": "2012-10-01",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "NICHOLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-466-3834",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187121608",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jaden Johns
• Jenaijah Johns, RECOVERY ASSISTANT
• Crissa Diane Johnson Breytenbach, SLP
• Robyn Johnson-Breytenbach
• Ambokile Johnson, RECOVERY ASSISTANT

• General Practice Dentistry in Conway, AR
• Providers in Conway, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; 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.