DR. JACK R CLARK (NPI# 1083840342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083840342 |
| Entity Type | Individual |
| Full Name | DR. JACK R CLARK |
| Credential | DMD |
| Practice Address |
1856 Lancaster Rd Homewood AL 35209-4114 |
| Practice Telephone | 2058712591 |
| Practice Fax Number | 2058791900 |
| Mailing Telephone | 2058712591 |
| Mailing Fax Number | 2058791900 |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2009-06-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
4290 | AL | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265571608 | Jack Douglas Clark | Ophthalmology | 7112 N Fresno St, Suite 100, Fresno, CA 93720-2940 | 2007-02-05 |
| 1346320140 | Jack Prow Clark | Family Medicine | 518 Ems D15 Ln, Syracuse, IN 46567-8026 | 2006-10-16 |
| 1306824016 | Jack Crowley Clark Sr. | Radiology | 1431 Centerpoint Blvd, Teamhealth Radiology Ste 100, Knoxville, TN 37932-1984 | 2006-01-03 |
| 1902881014 | Jack J Clark | Chiropractor | 6015 E State Blvd, Fort Wayne, IN 46815-7638 | 2005-12-12 |
| 1477799112 | Jack Clark | Counselor | 4411 N Cedar Ave, Fresno, CA 93726-2538 | 2008-12-31 |
| 1841311487 | Jack Malcolm Clark IIi | Social Worker | 7711 Madonna, San Antonio, TX 78216-6620 | 2007-04-02 |
| 1902992837 | Jack O. Clark | Internal Medicine | 450 E Main St, Rexburg, ID 83440 | 2006-10-05 |
| 1427092857 | Jack C Clark | Family Medicine | 103 Midlake Dr, Knoxville, TN 37918-3039 | 2006-06-15 |
| 1588616882 | Jack Lewis Clark | Oral & Maxillofacial Surgery | 21700 Northwestern Hwy, Suite 1290, Southfield, MI 48075-4906 | 2006-05-16 |
| 1073563847 | Jack Clark | Internal Medicine | 1528 Del Prado Blvd S, Cape Coral, FL 33990-3798 | 2006-05-11 |
| Street Address |
1856 LANCASTER RD |
| City | HOMEWOOD |
| State | AL |
| Zip Code | 35209-4114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407276041 | Wortham Dental | Dentist | 1856 Lancaster Rd, Homewood, AL 35209-4114 | 2014-04-22 |
| 1871935585 | Benjamin Thomas Wortham | Dentist | 1856 Lancaster Rd, Homewood, AL 35209-4114 | 2013-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437793510 | Marissa M Mcintyre | Registered Nurse | 3401 Independence Drive, Suite 221, Birmingham, AL 35209 | 2019-11-01 |
| 1093284457 | Patriot Healthcare of Alabama, LLC | Family Medicine | 2045 Brookwood Medical Center Drive, Suite 1, Birmingham, AL 35209 | 2018-11-15 |
| 1164902268 | Lucy Johnston | Physician Assistant | 1602 Woodfern Dr, Homewood, AL 35209 | 2018-08-17 |
| 1881184646 | Wade Louis Grady | Specialist/Technologist | 800 Larkshore Drive, Birmingham, AL 35209 | 2018-05-16 |
| 1154823029 | Taylor Payne | Physical Medicine & Rehabilitation | 109 Devon Dr, Birmingham, AL 35209 | 2018-03-06 |
| 1396251542 | 1st America Infusion Services LLC | Durable Medical Equipment & Medical Supplies | 120 Oxmoor Blvd Ste 100, Birmingham, AL 35209 | 2017-12-26 |
| 1376060954 | Hannah Holloway | Specialist/Technologist | 725 Crest Lane, Birmingham, AL 35209 | 2017-08-24 |
| 1558887463 | Paul A Rhodes | Nurse Practitioner | 631 Beacon Center Office Park, Suite 108, Birmingham, AL 35209 | 2017-08-22 |
| 1538542196 | Proteus Molecular and Clinical Lab LLC | Clinical Medical Laboratory | 218 Summit Pkwy, Suite 250, Homewood, AL 35209 | 2015-07-01 |
| 1124407739 | Randall Alban | Nurse Practitioner | 2100 Southbridge Parkway, Suite 650, Birmingham, AL 35209 | 2015-05-28 |
| Find all providers in zip 35209 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831702307 | Sms Dental LLC | Dentist | 17727 Halsted St, Homewood, IL 60430 | 2020-08-25 |
| 1144756461 | Diamond Smiles Homewood | Dentist | 112 Broadway St, Homewood, AL 35209-5312 | 2017-05-05 |
| 1467688614 | University Dental Associates | Dentist | 18213 Dixie Hwy, Homewood, IL 60430-2205 | 2009-06-02 |
| 1568672749 | Dr. Robert K. Rudolph, D.m.d., PC | Dentist | 1754 Oxmoor Rd, Homewood, AL 35209-4056 | 2007-05-23 |
| 1609994094 | Thomas Walton Erickson | Dentist | 18019 Dixie Hwy Ste 1b, Homewood, IL 60430-3059 | 2007-03-26 |
| 1306970397 | Eldridge&eldridge Dds PC | Dentist | 1944 Ridge Rd, Homewood, IL 60430-1730 | 2007-03-14 |
| 1235283821 | Drs. Kreuz and Duffner, Dds, Ltd. | Dentist | 18040 Park Ave, Homewood, IL 60430-1606 | 2007-01-22 |
| 1669520813 | Walter Douglas Flor | Dentist | 18340 Governors Hwy, Homewood, IL 60430 | 2007-01-06 |
| 1235295460 | David Duane Mayer | Dentist | 18114 Gottschalk Ave, Homewood, IL 60430-2208 | 2006-12-30 |
| 1346337557 | Central Dentistry, PC | Dentist | 2901 Central Ave, Homewood, AL 35209-2505 | 2006-10-08 |
| Find all providers in HOMEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.