DR. SAMANTHA ALEXANDRIA CLARK (NPI# 1174967277) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174967277 |
| Entity Type | Individual |
| Full Name | DR. SAMANTHA ALEXANDRIA CLARK |
| Credential | DDS |
| Practice Address |
5 4th Ave. E. Polson MT 59860 |
| Mailing Address |
P.o. Box 880 St. Ignatius MT 59865 |
| Practice Telephone | 4067453525 |
| Practice Fax Number | 4067453529 |
| Mailing Telephone | 4067453525 |
| Mailing Fax Number | 4067453529 |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2015-09-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
12012102A | IN | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
390200000 | IN | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710593462 | Samantha Clark | Student in an Organized Health Care Education/Training Program | 182 Chickasaw Trl, Pontotoc, MS 38863-8857 | 2020-09-18 |
| 1285268177 | Samantha Fay Clark | Behavior Technician | 990d Klamath Ln, Yuba City, CA 95993-8961 | 2020-02-28 |
| 1225525298 | Samantha R Clark | Case Manager/Care Coordinator | Juneau County Dept. of Human Services, 200 Hickory Street, Mauston, WI 53948-2101 | 2018-04-16 |
| 1699186841 | Samantha Clark | Obstetrics & Gynecology | 224 W Exchange St Ste 420, Akron, OH 44302-1718 | 2014-05-09 |
| 1225636442 | Samantha Clark | Pharmacist | 3914 Capital Blvd, Raleigh, NC 27604-3412 | 2020-10-09 |
| 1902430630 | Samantha Clark | Behavior Technician | 1620 N Main St Ste 1, Walnut Creek, CA 94596-4653 | 2020-03-03 |
| 1366081036 | Samantha Clark | Case Manager/Care Coordinator | 801 Hazen St Ste C, Paw Paw, MI 49079-2008 | 2019-12-30 |
| 1144869900 | Samantha Jane Clark | Pharmacist | 330 Pine Tree Rd, Ithaca, NY 14850-2819 | 2019-12-26 |
| 1548816630 | Samantha Clark | Occupational Therapist | 1797 King Ave, Kings Mills, OH 45034-1721 | 2019-08-14 |
| 1871154443 | Samantha Jeanine Clark | Marriage & Family Therapist | 2621 Oswell St Ste 119, Bakersfield, CA 93306-3172 | 2019-06-25 |
| Street Address |
5 4TH AVE. E. |
| City | POLSON |
| State | MT |
| Zip Code | 59860 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083750731 | Milissa Renee Grandchamp | Registered Nurse | 5 4th Ave. E., Polson, MT 59860 | 2007-01-29 |
| 1750626693 | Joshua Joseph Labau | Pharmacist | 5 4th Ave. E., Polson, MT 59860 | 2012-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679095020 | Ashley J Gilham | Registered Nurse | #5 4th Ave E., Polson, MT 59860 | 2017-07-07 |
| 1225585532 | St. Luke Community Hospital | Clinic/Center | 107 Ridgewater Dr., Polson, MT 59860 | 2016-09-02 |
| 1306202163 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 7 13th Ave East, Polson, MT 59860 | 2016-01-11 |
| 1154730364 | Wanda L King | Dietitian, Registered | 6 Thirteenth Avenue East, Poslon, MT 59860 | 2014-08-13 |
| 1104255637 | Dacia Lee Antiste-fisher | Counselor | #5 4th Ave. E., Polson, MT 59860 | 2013-11-05 |
| 1154758134 | Richard Pierre | Pharmacy Technician | 5 4th Ave E., Polson, MT 59860 | 2013-10-04 |
| 1154755197 | Wal-mart Stores, Inc | Durable Medical Equipment & Medical Supplies | 36318 Memory Lane, Polson, MT 59860 | 2013-08-27 |
| 1245582022 | Catherine D Addison | Registered Nurse | 5 4th Ave. East, Polson, MT 59860 | 2012-10-04 |
| 1114220787 | Erika Ann Weber | Social Worker | #5 4th Ave. E, Polson, MT 59860 | 2010-12-21 |
| 1942431473 | Lisa L. Scalpane | Counselor | 803 Main Street, Suite C, Polson, MT 59860 | 2009-07-31 |
| Find all providers in zip 59860 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124626262 | Havre Pediatric Dentistry | Dentist | 515 14th St W, Havre, MT 59501-5121 | 2020-10-12 |
| 1841839230 | Trailhead Pediatric Dentistry | Dentist | 513 Hilltop Rd Ste 5, Billings, MT 59105-2375 | 2020-01-02 |
| 1770051567 | Glasgow Pediatric Dentistry | Dentist | 90 Us Highway 2 E Ste A, Glasgow, MT 59230-2009 | 2018-11-09 |
| 1578081428 | 3 Rivers Pediatric Dentistry | Dentist | 225 Hastings Ave, Missoula, MT 59801-5951 | 2017-08-30 |
| 1477911618 | Chad Cattron | Dentist | 155 Hutton Ranch Rd # 102, Kalispell, MT 59901-2133 | 2016-02-02 |
| 1720446289 | Clint Chlarson | Dentist | 3042 Golden Acres Dr, Billings, MT 59106-2254 | 2016-01-29 |
| 1346631249 | Tanner Douglas Bennion | Dentist | 2700 Grand Ave Ste B, Billings, MT 59102-2682 | 2015-02-12 |
| 1972921450 | Gabriel Dawson | Dentist | 795 Sunset Blvd Ste C, Kalispell, MT 59901-3610 | 2014-04-02 |
| 1457615494 | Emily Rockne | Dentist | 3116 Saddle Dr Ste 1, Helena, MT 59601-8645 | 2012-06-25 |
| 1821385915 | Justin Matthew Stevens | Dentist | 3980 Valley Commons Dr, Bozeman, MT 59718-5603 | 2011-07-08 |
| Find all providers with the same taxonomy | ||||
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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.