DR. BRENT WAYNE CLARK DMD NPI 1174636419

NPI Information

  • NPI: 1174636419
  • Provider Name: DR. BRENT WAYNE CLARK, DMD
  • Classification: Dentist - 1223P0221X
  • Specialization: Pediatric Dentistry
  • Entity Type: Individual
  • Address: FLUGPLATZ ERBENHEIM 1040
    WIESBADEN, NY
    ZIP 65205
  • Phone: (314) 590-1515

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NPI Details

DR. Brent Wayne Clark, DMD is a pediatric dentistry dentist in Wiesbaden, NY. 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. Brent Wayne Clark, DMD NPI is 1174636419. 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:

FLUGPLATZ ERBENHEIM 1040
WIESBADEN, NY
ZIP 65205
Phone: (314) 590-1515

The enumeration date for this NPI number is 8/17/2006 and was last updated on 7/10/2025.

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
11223P0221XDentistPediatric Dentistry14192587-9926UTAHYes

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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