DR. SHANE THOMAS CLARK DMD NPI 1003220203

NPI Information

  • NPI: 1003220203
  • Provider Name: DR. SHANE THOMAS CLARK, DMD
  • Classification: Dentist - 1223E0200X
  • Specialization: Endodontics
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2800 COORS BLVD NW
    ALBUQUERQUE, NM
    ZIP 87120
  • Phone: (505) 352-1166

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NPI Details

DR. Shane Thomas Clark, DMD is an endodontics dentist in Albuquerque, NM. The provider is 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. DR. Shane Thomas Clark, DMD NPI is 1003220203. 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:

2800 COORS BLVD NW
ALBUQUERQUE, NM
ZIP 87120-204
Phone: (505) 352-1166

The NPI 1003220203 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 6/16/2014 and was last updated on 9/26/2015.

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
11223E0200XDentistEndodonticsDD4100NEW MEXICOYes

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: 11/21/2025

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