DR. MICHAEL V. CLARK DDS NPI 1386778520

NPI Information

NPI: 1386778520
Provider Name: DR. MICHAEL V. CLARK, DDS
Classification: Dentist - 1223P0221X
Entity Type: Individual

Specialization: Pediatric Dentistry

Address:
6900 YELLOWTAIL RD
SUITE 100
CHEYENNE, WY
ZIP 82009
Phone: (307) 635-9251
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DR. Michael V. Clark, DDS is a pediatric dentistry dentist in Cheyenne, WY. The provider is 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. DR. Michael V. Clark, DDS NPI is 1386778520. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

6900 YELLOWTAIL RD
SUITE 100
CHEYENNE, WY
ZIP 82009-102
Phone: (307) 635-9251
Fax: (307) 635-9218

The enumeration date for this NPI number is 3/16/2007 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0221X	Dentist	Pediatric Dentistry	1108	WYOMING	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	119846700	MEDICAID	WYOMING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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