DR. BRADLEY J CLARK (NPI# 1114052966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114052966 |
| Entity Type | Individual |
| Full Name | DR. BRADLEY J CLARK |
| Credential | DDS |
| Practice Address |
310 S 9th Ave Broken Bow NE 68822-2014 |
| Mailing Address |
Po Box 117 310 South 9th Ave. Broken Bow NE 68822-0117 |
| Practice Telephone | 3088722575 |
| Mailing Telephone | 3088722575 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
6126 | NE | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | BLUE CROSS BLUE SHIELD # | 5251 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395331 | Bradley Layton Clark | Technician | 8620 Sewell Creek Rd, Meadow Bridge, WV 25976-7674 | 2020-10-26 |
| 1124354964 | Bradley Clark | Emergency Medicine | 423 E Elaine Cir, Inkom, ID 83245-1716 | 2009-10-29 |
| 1144683863 | Bradley Layton Clark | Student in an Organized Health Care Education/Training Program | 1500 S Main St, Fort Worth, TX 76104-4917 | 2016-03-31 |
| 1407252679 | Bradley Clark | Dentist | 450 Sutter St, Suite 2109, San Francisco, CA 94108-4206 | 2014-11-14 |
| 1649532466 | Bradley J Clark | Pediatrics | 3485 W 5200 S, Roy, UT 84067-9438 | 2012-06-08 |
| 1639431307 | Bradley Walton Clark | Internal Medicine | 186 Kimel Park Dr, Winston Salem, NC 27103 | 2012-06-08 |
| 1447510722 | Bradley A Clark | Internal Medicine | 10590 N Meridian St, Indianapolis, IN 46290 | 2012-05-21 |
| 1427383124 | Bradley W Clark | Counselor | 9333 E 21st St N, Wichita, KS 67206-2927 | 2009-10-14 |
| 1316107642 | Bradley C Clark | Pediatrics | 3415 Bainbridge Ave, Bronx, NY 10467-2403 | 2008-06-10 |
| Street Address |
310 S 9TH AVE |
| City | BROKEN BOW |
| State | NE |
| Zip Code | 68822-2014 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659898229 | Lauren Eliz Zimbelman | Occupational Therapy Assistant | Brookestone View, 850 Laurel Parkway Drive, Broken Bow, NE 68822 | 2017-08-24 |
| 1063868032 | Tanner Johnson | Specialist/Technologist | 79568 Sumner Rd., Broken Bow, NE 68822 | 2016-05-10 |
| 1730571837 | Quality Senior Villages | Clinic/Center | 715 Arapahoe Lane, Broken Bow, NE 68822 | 2015-02-26 |
| 1346660743 | Sheila Erickson | Case Manager/Care Coordinator | 323 S 7th Street, Broken Bow, NE 68822 | 2014-04-24 |
| 1497926570 | Sarah Tove Hansen | Community Health Worker | 850 Laurel Parkway Dr, Broken Bow, NE 68822 | 2008-03-18 |
| 1144320144 | John C Evans | Nurse Anesthetist, Certified Registered | 145 Memorial Dr., Broken Bow, NE 68822 | 2006-09-22 |
| 1588764583 | Timothy Bart Johnson | Nurse Anesthetist, Certified Registered | 79568 Sumner Road, Broken Bow, NE 68822 | 2006-09-22 |
| 1578668232 | Central Nebraska Medical Clinic PC | Family Medicine | 145 Memorial Drive, Broken Bow, NE 68822 | 2006-09-14 |
| 1366544033 | Robert R Kahnk | Family Medicine | 145 Memorial Dr, Broken Bow, NE 68822 | 2006-09-02 |
| 1891897997 | David A Minnick | Family Medicine | 145 Memorial Dr, Broken Bow, NE 68822 | 2006-09-01 |
| Find all providers in zip 68822 | ||||
| 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 |
|---|---|---|---|---|
| 1720158280 | Stacy Leigh Solomon | Dentist | 2021 S E St, Ste #5, Broken Bow, NE 68822-1848 | 2006-11-09 |
| 1801800107 | Orr Family Dentistry | Dentist | 1509 S Park Dr, Broken Bow, OK 74728-5722 | 2006-07-29 |
| 1578770970 | Mark Wade Ziegler | Dentist | 6026 Battiest Pickens Rd, Broken Bow, OK 74728-5033 | 2007-05-16 |
| 1386658904 | Owen Bradley Hearne | Dentist | 400 Main St, Broken Bow, OK 74728-2982 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891313508 | Eric Ahrens | Dentist | 3915 4th Ave, Kearney, NE 68845-2838 | 2020-07-09 |
| 1275150401 | Vy T Vu | Dentist | 6835 S 27th St Ste 2, Lincoln, NE 68512-4824 | 2020-07-03 |
| 1326664483 | Robert Kirkland | Dentist | 1919 S 40th St Ste 200, Lincoln, NE 68506-5247 | 2020-06-24 |
| 1265058861 | Christine Ruth Bergman | Dentist | 2121 S 70th Street, Lincoln, NE 68506 | 2020-06-19 |
| 1881218428 | South Lincoln Family Dentistry LLC | Dentist | 2121 S. 70th Street, Lincoln, NE 68506 | 2020-05-29 |
| 1982240024 | Autumn Brown | Dentist | 989375 Nebraska Medical Ctr Fl Center3, Omaha, NE 68198-9375 | 2019-11-25 |
| 1619529617 | Brenton Joseph Matulka | Dentist | 575 Fallbrook Blvd Ste 107, Lincoln, NE 68521-9040 | 2019-07-10 |
| 1720646987 | Lindsey White | Dentist | 40890 W. Hwy 6 & 34, Cambridge, NE 69022 | 2019-06-03 |
| 1407411507 | Today's Dental 74th Plaza, LLC | Dentist | 900 S 74th Plz Ste 300, Omaha, NE 68114-4667 | 2019-05-03 |
| 1104390855 | Millard Hills Dental Health Center LLC | Dentist | 14202 Y Street, Omaha, NE 68137 | 2019-01-16 |
| Find all providers with the same taxonomy | ||||
| City | BROKEN BOW |
| Zip Code | 68822 |
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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.