CLARK ENDODONTICS LLC (NPI# 1922586262) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922586262 |
| Entity Type | Organization |
| Organization Name | CLARK ENDODONTICS LLC |
| Other Organization Name | ADVANCED ENDODONTICS |
| Practice Address |
7520 Montgomery Blvd Ne Bldg E1 Albuquerque NM 87109 |
| Mailing Address |
7520 Montgomery Blvd Ne Bldg E1 Albuquerque NM 87109-1554 |
| Practice Telephone | 5057971212 |
| Practice Fax Number | 5058231831 |
| Mailing Telephone | 5057971212 |
| Mailing Fax Number | 5058231831 |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2018-07-30 |
| Authorized Official Name | SHANE T CLARK (DOCTOR/OWNER) |
| Authorized Official Telephone | 5057971212 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
DD4100 | NM | Dental Providers |
| Other Name | Type Code |
|---|---|
| Advanced Endodontics | Doing Business As Name - Organization |
| Street Address |
7520 MONTGOMERY BLVD NE BLDG E1 |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386286367 | Mikaela Epaloose | Behavior Technician | 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-10-11 |
| 1245872464 | Marsha Director | Behavior Technician | 100 Sun Avenue Ne, Ste 650, Albuquerque, NM 87109 | 2019-10-09 |
| 1720637499 | Nancy Gail Vice | Technician | 7319 Laguna Niguel Drive Ne, Albuquerque, NM 87109 | 2019-09-05 |
| 1598314411 | Chau Vu | Behavior Technician | Attn: Behavioral Health Works 100 Sun Avenue N.e., Suite 650, Albuquerque, NM 87109 | 2019-09-04 |
| 1932753498 | Noelle Nielsen | Behavior Technician | 6401 Academy Rd. Ne Apt. 189, Albuquerque, NM 87109 | 2019-08-01 |
| 1952967952 | Caridad Merkel | Obstetrics & Gynecology | 6100 Pan American Fwy Ne Suite 450, Albuquerque, NM 87109 | 2019-05-15 |
| 1043795149 | Margaret Mcconville | Physical Therapist | Lovelace Women's Hospital Outpatient Rehabilitation, 4600 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-09-25 |
| 1447736202 | Melissa Christine Scott | Registered Nurse | Lovelace Women's Hospital, 4701 Montgomery Blvd Ne, Albuquerque, NM 87109 | 2018-07-16 |
| 1508351990 | Gianna Nicole Casarez-quintana | Dentist | 7520 Montgomery Blvd Ne Bldg E10, Albuquerque, NM 87109 | 2018-06-27 |
| 1154818169 | Danessa Rene Decosta | Day Training/Habilitation Specialist | 6308 Lola Dr Ne, Albuquerque, NM 87109 | 2018-04-16 |
| Find all providers in zip 87109 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669024840 | Robert Hochberg, Dds, LLC | Dentist | 7520 Montgomery Blvd Ne Ste B, Building C, Albuquerque, NM 87109-1521 | 2019-07-09 |
| 1003220203 | Shane Thomas Clark | Dentist | 2800 Coors Blvd Nw, Albuquerque, NM 87120-1204 | 2014-06-16 |
| 1780811984 | Ryan Hastiin Wilson | Dentist | 6810 Menaul Blvd Ne Ste B, Albuquerque, NM 87110 | 2009-06-15 |
| 1356508931 | David Lloyd Hadley | Dentist | 10409 Montgomery Pkwy Ne Ste 100, Albuquerque, NM 87111-3862 | 2008-05-21 |
| 1760671705 | New Mexico Endodontic Specialists, PC | Dentist | 10151 Montgomery Blvd Ne Ste 2b, Albuquerque, NM 87111-3664 | 2007-10-16 |
| 1891989158 | Jeffrey Michael Clark | Dentist | 10429 Lagrima De Oro Rd Ne, Albuquerque, NM 87111 | 2007-08-30 |
| 1134334907 | Colin Simeon Shaw | Dentist | 4620 Jefferson Ln Ne Ste C, Albuquerque, NM 87109-2120 | 2007-05-14 |
| 1063493427 | Advanced Endodontics | Dentist | 7520 Montgomery Blvd, E1, Albuquerque, NM 87109 | 2005-11-10 |
| 1063940237 | John Steffensen | Dentist | 2800 Coors Blvd Nw Ste A, Albuquerque, NM 87120-1204 | 2017-05-31 |
| 1568854339 | Papworth Endodontics | Dentist | 10151 Montgomery Blvd Ne, Suite 1-c, Albuquerque, NM 87111-3670 | 2015-03-03 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87109 |
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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.