DR. SHANE THOMAS CLARK (NPI# 1003220203) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003220203 |
| Entity Type | Individual |
| Full Name | DR. SHANE THOMAS CLARK |
| Credential | DMD |
| Practice Address |
2800 Coors Blvd Nw Albuquerque NM 87120-1204 |
| Mailing Address |
8400 Oakland Ave Ne Albuquerque NM 87122-2721 |
| Practice Telephone | 5053521166 |
| Mailing Telephone | 5126898382 |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2015-09-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
DD4100 | NM | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972910305 | Shane Clark | Specialist/Technologist | 2151 Fews Chapel Rd, Greer, SC 29651-4946 | 2014-07-17 |
| 1437446440 | Shane Alexander Clark | Optometrist | 5734 Sheridan Lake Rd, Suite 202, Rapid City, SD 57702-8811 | 2011-06-29 |
| 1902391477 | Shane Clark | Student in an Organized Health Care Education/Training Program | 401 W Greenlawn Ave, Lansing, MI 48910-2819 | 2018-06-27 |
| 1548495336 | Shane Chamberlain Clark | Dermatology | 5300 Far Hills Avenue, Dayton, OH 45429-2347 | 2009-05-21 |
| 1265573067 | Shane Alan Clark | Anesthesiology | 6606 Lbj Fwy, Suite 200, Dallas, TX 75240-6533 | 2007-02-12 |
| Street Address |
2800 COORS BLVD NW |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87120-1204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225407604 | Michael Ross Conner | Dentist | 2800 Coors Blvd Nw, A, Albuquerque, NM 87120-1204 | 2015-09-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971919 | Erica Denise Ortiz | Social Worker | 6212 Casa Blanca Dr Nw, Albuquerque, NM 87120 | 2020-10-27 |
| 1770133589 | Laura Lee Smith | Technician | 5112 Vista De Luz Nw, Albuquerque, NM 87120 | 2019-09-13 |
| 1285282715 | Aiden Charles Martinez | Case Manager/Care Coordinator | 6704 Nueva Pierda Street Nw, Albuquerque, NM 87120 | 2019-08-28 |
| 1831753508 | Jennifer Lydia Castro | Nurse Practitioner | 8428 Hawk Eye Rd Nw, Albuquerque, NM 87120 | 2019-04-27 |
| 1518425065 | Jean Louise Ramsey | Counselor | Office Alternatives/ The Center for Life Changes, 6300 Riverside Plaza Nw, Suite 100, Albuquerque, NM 87120 | 2019-03-04 |
| 1689147365 | Stairway Recovery, LLC | Family Medicine | 6300 Riverside Plaza Ln Nw Ste 118 #96523, Albuquerque, NM 87120 | 2019-01-06 |
| 1417443276 | Kyle Thomas Lantz | Dentist | 2800-a Coors Blvd Nw, Albuquerque, NM 87120 | 2018-07-05 |
| 1437669736 | Beatrice Ottomanelli | Day Training/Habilitation Specialist | 9180 Coors Blvd. Nw, Apt. 3307, Albuquerque, NM 87120 | 2017-10-02 |
| 1740705516 | Alianza Home Care, LLC | Home Health | 8307 Casa Negra Ct Nw, Albuquerque, NM 87120 | 2017-08-13 |
| 1366963399 | Jamie Farris | Registered Nurse | 8201 Golf Course Road Northwest, Suite D3 #121, Albuquerque, NM 87120 | 2017-06-29 |
| Find all providers in zip 87120 | ||||
| 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 |
| 1922586262 | Clark Endodontics LLC | Dentist | 7520 Montgomery Blvd Ne Bldg E1, Albuquerque, NM 87109 | 2018-07-30 |
| 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 | 87120 |
Please comment or provide details below to improve the information on DR. SHANE THOMAS CLARK.
| 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.