DR. GLEN THOMAS CLARK (NPI# 1740339233) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740339233 |
| Entity Type | Individual |
| Full Name | DR. GLEN THOMAS CLARK |
| Credential | DDS |
| Practice Address |
925 W 34th St Room #151 Los Angeles CA 90089-0641 |
| Practice Telephone | 2137407405 |
| Mailing Telephone | 2137407405 |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2011-12-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 24282 | CA | Dental Providers |
| N | 1223P0106X |
Dentist Specialization: Oral and Maxillofacial Pathology |
24282 | CA | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
24282 | CA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | RAILROAD MEDICARE | P00182356 | 01 |
| CA | BLUE CROSS BLUE SHIELD | ZZZ34010A | 01 |
| CA | DENTICAL | U0100701 | 01 |
| CA | DENTICAL | G100701 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952585218 | Glen Antonio Clark IIi | Counselor | 1301 Pierce St., San Francisco, CA 94115 | 2007-12-21 |
| 1932110657 | Glen T Clark | Emergency Medicine | 468 Cadieux Rd, Grosse Pointe, MI 48230-1507 | 2006-08-10 |
| Street Address |
925 W 34TH ST ROOM #151 |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90089-0641 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760488167 | Parish Paymon Sedghizadeh | Dentist | 925 W 34th St, Den 4276, Los Angeles, CA 90089-0641 | 2005-06-22 |
| 1609405984 | Aimi Nguyen | Student in an Organized Health Care Education/Training Program | 925 W 34th St, Los Angeles, CA 90089-0058 | 2020-04-07 |
| 1902435829 | Amy Engel | Student in an Organized Health Care Education/Training Program | 925 W 34th St, Los Angeles, CA 90089-0058 | 2020-04-02 |
| 1023645009 | Andrea Taguinod | Student in an Organized Health Care Education/Training Program | 925 W 34th St, Los Angeles, CA 90089-0058 | 2020-03-27 |
| 1881258747 | Vi-khoi K. Duong | Student in an Organized Health Care Education/Training Program | 925 W 34th St, Los Angeles, CA 90089-0058 | 2019-04-26 |
| 1497319222 | Jessica Baisley | Student in an Organized Health Care Education/Training Program | 925 W 34th St, Los Angeles, CA 90089-0058 | 2019-04-26 |
| 1669036505 | Stephen Patrick O'donnell | Student in an Organized Health Care Education/Training Program | 925 W 34th St, Los Angeles, CA 90089-0058 | 2019-04-25 |
| 1760944078 | Ella Saeed | Student in an Organized Health Care Education/Training Program | 925 W 34th St, Los Angeles, CA 90089-0058 | 2019-04-04 |
| 1720549306 | Philip Yoong | Student in an Organized Health Care Education/Training Program | 925 W 34th St, Los Angeles, CA 90089-0058 | 2019-03-27 |
| 1003307976 | Irene L Ching | Dentist | 925 W 34th St, Los Angeles, CA 90089 | 2018-05-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962980201 | Brittany Nicole Beasley | Psychologist | 1031 W. 34th St., 3rd Floor, Suite 304, Los Angeles, CA 90089 | 2018-07-30 |
| 1548763675 | Tien Ng | Pharmacist | Usc School of Pharmacy, 1985 Zonal Ave, Los Angeles, CA 90089 | 2018-03-15 |
| 1821503236 | Theodore James Goldsmith | Psychologist | 1031 W 34th St Fl 3, Los Angeles, CA 90089 | 2017-12-07 |
| 1174046890 | Erin Lindsay Mcintyre | Occupational Therapist | 1540 Alcazar Street, Chp 133, Los Angeles, CA 90089 | 2017-07-25 |
| 1831645571 | Alyssa Cantal | Student in an Organized Health Care Education/Training Program | 1540 Alcazar St., Chp-133, Los Angeles, CA 90089 | 2016-09-01 |
| 1841744638 | Cheryl Jonghee Park | Dentist | 925 W. 34th Street, Room 4363, Los Angeles, CA 90089 | 2016-08-09 |
| 1528412376 | Mark Duan Ard Jr. | Psychiatry & Neurology | 1975 Zonal Ave, Los Angeles, CA 90089 | 2016-04-18 |
| 1851766679 | Samantha Trout | Student in an Organized Health Care Education/Training Program | 1540 Alcazar St Chp-133, Los Angeles, CA 90089 | 2015-12-04 |
| 1215324363 | Upama Giri | Student in an Organized Health Care Education/Training Program | 1441 Eastlake Ave Ste 3470, Los Angeles, CA 90089 | 2015-04-15 |
| 1982015004 | Martrice Ways | Student in an Organized Health Care Education/Training Program | 3375 South Hoover Street, Suite H201, Los Angeles, CA 90089 | 2014-05-12 |
| Find all providers in zip 90089 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992481 | Centinela Joseph Dental Group | Dentist | 6907 La Tijera Blvd, Los Angeles, CA 90045-1906 | 2020-11-02 |
| 1134729601 | Enas Tayyem | Dentist | 2100 N Beachwood Dr Apt 303, Los Angeles, CA 90068-3442 | 2020-10-26 |
| 1639776073 | Stephanie Jeanne Bauman | Dentist | 3060 W Olympic Blvd Apt 438, Los Angeles, CA 90006-3838 | 2020-10-08 |
| 1316544570 | Azzah Widatalla | Dentist | 5455 Wilshire Blvd Ste 850, Los Angeles, CA 90036-4234 | 2020-10-01 |
| 1104433796 | Irena Starchenko | Dentist | 2007 Wilshire Blvd Ste 525, Los Angeles, CA 90057-3518 | 2020-09-28 |
| 1134734353 | Mark Park | Dentist | 404 Shatto Pl Apt 443, Los Angeles, CA 90020-1739 | 2020-09-14 |
| 1740895150 | Chantelle Aabedi | Dentist | 2711 Casiano Rd, Los Angeles, CA 90077-9007 | 2020-09-11 |
| 1801401542 | Yojeong Cho | Dentist | 621 S Western Ave Ste 201, Los Angeles, CA 90005-3042 | 2020-09-10 |
| 1518572247 | William Hwang | Dentist | 2727 W Olympic Blvd Ste 311, Los Angeles, CA 90006-2699 | 2020-09-10 |
| 1912511056 | Shervin Moshashaei | Dentist | 1420 Peerless Pl Apt 212, Los Angeles, CA 90035-2869 | 2020-09-05 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90089 |
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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.