L L CLARK DDS SC (NPI# 1497713176) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497713176 |
| Entity Type | Organization |
| Organization Name | L L CLARK DDS SC |
| Practice Address |
105 East Bluff Street Boscobel WI 53805-9802 |
| Practice Telephone | 6083754549 |
| Practice Fax Number | 6083754665 |
| Mailing Telephone | 6083754549 |
| Mailing Fax Number | 6083754665 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. LARRY LEE CLARK (DENTIST) |
| Authorized Official Telephone | 6083754549 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
5001678015 | WI | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 33549200 | 05 |
| Street Address |
105 EAST BLUFF STREET |
| City | BOSCOBEL |
| State | WI |
| Zip Code | 53805-9802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841746450 | Boscobel Family Dental, LLC | Dentist | 105 E. Bluff Street, Boscobel, WI 53805 | 2016-09-01 |
| 1063821890 | Rebecca Augustine | Pharmacist | 1028 Wisconsin Ave., Boscobel, WI 53805 | 2014-08-06 |
| 1164487856 | Richard A Graf | Urology | 200 W Bluff St, Boscobel, WI 53805 | 2006-04-18 |
| 1932136181 | Marija Zakarija | Emergency Medicine | 205 Parker St, Boscobel, WI 53805 | 2006-06-26 |
| 1386727972 | Dr Michael S Mecikalski Sc | Dentist | 310 Parker Street, Boscobel, WI 53805-0188 | 2006-10-24 |
| 1770873440 | Michael S. Mecikalski | Dentist | 310 Parker Street, Boscobel, WI 53805-0188 | 2011-04-14 |
| 1821458852 | Tammy Shepherd | Licensed Practical Nurse | 501 Chestnut St, Boscobel, WI 53805-1130 | 2016-03-03 |
| 1144382011 | Burton Dale Cox Jr. | Family Medicine | 1101 Morrison Dr, Hsu, Boscobel, WI 53805-1180 | 2006-12-15 |
| 1013490101 | Rebecca Miller LLC | Counselor | 406 Elm St, Boscobel, WI 53805-1216 | 2018-09-13 |
| 1306323803 | Ashley Hady, LLC | Community/Behavioral Health | 406 Elm St, Boscobel, WI 53805-1216 | 2018-07-26 |
| Find all providers in zip 53805 | ||||
| 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 |
|---|---|---|---|---|
| 1841746450 | Boscobel Family Dental, LLC | Dentist | 105 E. Bluff Street, Boscobel, WI 53805 | 2016-09-01 |
| 1386727972 | Dr Michael S Mecikalski Sc | Dentist | 310 Parker Street, Boscobel, WI 53805-0188 | 2006-10-24 |
| 1356361935 | Keith W. Nance | Dentist | 105 E Bluff St, Boscobel, WI 53805-1610 | 2006-07-19 |
| 1174945919 | Larry Clark | Dentist | 105 E Bluff St, Boscobel, WI 53805-1610 | 2014-01-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700496007 | Elizabeth R Friend | Dentist | 440 Science Dr Ste 100, Madison, WI 53711-1064 | 2020-08-03 |
| 1205451598 | Tysen Wood | Dentist | 605 S 24th Ave Ste 10, Wausau, WI 54401-1705 | 2020-06-11 |
| 1841814035 | Vicki Shah | Dentist | 220 E Commerce Ct, Elkhorn, WI 53121-4371 | 2020-06-03 |
| 1790308666 | Michelle Zellmer | Dentist | 333 W Brown Deer Rd Ste A, Fox Point, WI 53217-2370 | 2020-05-26 |
| 1568083772 | Kolver Matos | Dentist | N112w16286 Mequon Rd, Germantown, WI 53022-3306 | 2020-04-28 |
| 1205466737 | Leyes Robers Dental LLC | Dentist | 3216 W County Rd Kk, Appleton, WI 54915 | 2020-01-23 |
| 1972133536 | Neha Solanki | Dentist | 1212 Horton St Ste 200, La Crosse, WI 54601-6289 | 2020-01-23 |
| 1023655131 | Pak Dental LLC | Dentist | 8241 S Howell Ave Ste 100, Oak Creek, WI 53154-8346 | 2019-12-09 |
| 1700428216 | Binninger Dentistry, LLC | Dentist | 12720 W North Ave Bldg B, Brookfield, WI 53005-4637 | 2019-10-16 |
| 1720629017 | Quirt Family Dentistry, S.c. | Dentist | W178n9379 Water Tower Pl, Menomonee Falls, WI 53051-8034 | 2019-10-08 |
| 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.