Christopher B Clark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19412 Issued in OH

Practice address

28321 Kensington LN
Perrysburg, OH 43551-4164

Phone

(419) 874-3333

Fax

(419) 874-9573

NPI assigned

Apr 19, 2007

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 OH

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

State licenses

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992922454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28321 KENSINGTON LN",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435514164",
            "telephone_number": "419-874-3333",
            "fax_number": "419-874-9573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28321 KENSINGTON LN",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435514164",
            "telephone_number": "419-874-3333",
            "fax_number": "419-874-9573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHRISTOPHER",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "19412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine L Church, LPCC, LICDC
• Churchills Perrysburg LTD
• Douglas I Cifuentes, D.O.
• Circle of Care Supportive Services
• CKC Medical Inc
• Madeline Elizabeth Clark, LPC
• Stephen E. Clark, M.D.
• Jennifer Ann Clayton, PTA
• Christina M Clemens, MSSA, LISW
• Aireal Patrice Clinton, LPC

• General Practice Dentistry in Perrysburg, OH
• Providers in Perrysburg, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.