DR. JOEL R. CLARK (NPI# 1790759439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790759439 |
| Entity Type | Individual |
| Full Name | DR. JOEL R. CLARK |
| Credential | D.D.S. |
| Practice Address |
1925 S Sossaman Rd 211 Mesa AZ 85209-4275 |
| Practice Telephone | 4805033764 |
| Practice Fax Number | 4803800336 |
| Mailing Telephone | 4805033764 |
| Mailing Fax Number | 4803800336 |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
5179 | AZ | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 713546 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366617243 | Joel Ellis Clark | Physical Therapist | 107 Rabbit Trl, Wilmore, KY 40390-1481 | 2008-04-23 |
| 1104247212 | Joel Clark I | Occupational Therapy Assistant | 2003 Cobb St, Farmville, VA 23901-2603 | 2013-12-17 |
| 1609906502 | Joel Ray Clark | Driver | 128 Scenega, Valdez, AK 99686 | 2007-03-07 |
| 1093773681 | Joel Robertson Clark | Podiatrist | 2250 Hayes St, Suite 4a, San Francisco, CA 94117 | 2006-05-03 |
| Street Address |
1925 S SOSSAMAN RD 211 |
| City | MESA |
| State | AZ |
| Zip Code | 85209-4275 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104008499 | Sossaman Dental Care | Dentist | 1925 S Sossaman Rd, #212, Mesa, AZ 85209-4275 | 2007-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013539568 | Wingfoot Wellness & Hormones LLC | Nurse Practitioner | 2500 S Power Road, Building 7 Suite 218, Mesa, AZ 85209 | 2020-05-07 |
| 1558916247 | Shiny Susan Thomas | Family Medicine | 7615,east Baseline Road, Mesa, AZ 85209 | 2019-08-08 |
| 1245798933 | Premier Care Medical Services Pllc | Clinic/Center | 7363 E Naranja Ave, Mesa, AZ 85209 | 2019-03-12 |
| 1518450568 | Mhb Services | Internal Medicine | 1301 S Crismon Road, Mesa, AZ 85209 | 2018-06-13 |
| 1174012934 | Andrew Swenson | Student in an Organized Health Care Education/Training Program | 10238 E. Hampton #406, Mesa, AZ 85209 | 2018-05-08 |
| 1689196057 | Monica R Meyer | Registered Nurse | 2424 S Rowen, Mesa, AZ 85209 | 2017-07-07 |
| 1629507041 | Rachel Ann Navarro | Occupational Therapist | 10431 E Natal Ave, Mesa, AZ 85209 | 2017-06-08 |
| 1073041331 | Michelle Resendez | Nurse Practitioner | 2500 S Power Rd, Bldg 7, Ste 218, Mesa, AZ 85209 | 2017-05-31 |
| 1275069569 | Michelle Amado | Nurse Practitioner | 2500 S. Power Rd, Bldg 7, Ste 218, Mesa, AZ 85209 | 2017-05-04 |
| 1982138079 | Warren Brent Thomas | Nurse Anesthetist, Certified Registered | 10632 E Kiva Ave, Mesa, AZ 85209 | 2017-04-14 |
| Find all providers in zip 85209 | ||||
| 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 |
|---|---|---|---|---|
| 1033750724 | Mesa Valley Dental LLC | Dentist | 1220 S Higley Rd Ste 206, Mesa, AZ 85206-4002 | 2019-10-03 |
| 1942841663 | Mesa Kidtastic Dental LLC | Dentist | 1240 W Southern Ave Ste 112, Mesa, AZ 85202-4882 | 2019-10-03 |
| 1194200980 | Highbury Dental Management, LLC | Dentist | 4425 S Mountain Rd, Suite 109, Mesa, AZ 85212 | 2018-09-27 |
| 1407344567 | Kids Dental Group Pllc | Dentist | 6239 E Brown Rd Ste 102, Mesa, AZ 85205-4933 | 2018-04-24 |
| 1861841918 | Ryan Blake | Dentist | 4425 S. Mountain Road, Ste 109, Mesa, AZ 85212 | 2016-06-09 |
| 1215281688 | Fiesta Kidtastic, LLC | Dentist | 1303 S Longmore Ste 1, Mesa, AZ 85202-9607 | 2012-11-06 |
| 1770831430 | Brian Glen Banks | Dentist | 2500 S Power Rd Ste 128, Mesa, AZ 85209 | 2012-08-28 |
| 1477811842 | Kids Dental Specialists LLC | Dentist | 1305 S Alma School Rd, Mesa, AZ 85210-2070 | 2012-04-24 |
| 1508178898 | John William Taylor | Dentist | 4540 E. Baseline Rd, Suite 102, Mesa, AZ 85206 | 2010-07-02 |
| 1245411644 | John W. Taylor, Dds, Pllc | Dentist | 4540 E Baseline Rd., Ste. 102, Mesa, AZ 85206 | 2007-11-14 |
| Find all providers in MESA | ||||
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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.