TRAVIS CLARK DDS LLC (NPI# 1093329914) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093329914 |
| Entity Type | Organization |
| Organization Name | TRAVIS CLARK DDS LLC |
| Practice Address |
1248 Columbus Ave Ste 8 Lebanon OH 45036-9005 |
| Mailing Address |
7845 Plantation Dr Mason OH 45040-5944 |
| Practice Telephone | 5139320432 |
| Practice Fax Number | 5139320152 |
| Mailing Telephone | 6149370509 |
| Mailing Fax Number | 5139320152 |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2020-09-08 |
| Authorized Official Name | DR. TRAVIS CLARK (DENTIST) |
| Authorized Official Telephone | 6149370509 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2668466 | 05 |
| Other Name | Type Code |
|---|---|
| Family Dental Care Of Lebanon | Doing Business As Name - Organization |
| Street Address |
1248 COLUMBUS AVE STE 8 |
| City | LEBANON |
| State | OH |
| Zip Code | 45036-9005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205479458 | Natasha Denney Arentz | Nurse Practitioner | 5787 Oh-63, Lebanon, OH 45036 | 2019-10-21 |
| 1265086573 | Eric Stone | Counselor | 5234 Oh-63, Lebanon, OH 45036 | 2019-07-25 |
| 1548730401 | Crystal Prater | Counselor | 5234 W Sr 63, Lebanon, OH 45036 | 2018-12-04 |
| 1922574284 | Ellen L Fink | Counselor | 5234 Sr 63, Lebanon, OH 45036 | 2018-10-15 |
| 1255832275 | Primary Care Partners of Ohio | Family Medicine | 726 E Main St Ste F205, Lebanon, OH 45036 | 2018-02-25 |
| 1548769599 | Chelsea R Perkins | Case Manager/Care Coordinator | 975 Kingsview Drive Bldg B, Lebanon, OH 45036 | 2018-02-06 |
| 1184133829 | Mary Bennett | Speech-Language Pathologist | 6760 Oh St Rt. 34, Lynchburg, OH 45036 | 2017-09-26 |
| 1699292912 | Robert Earl Offutt | Counselor | 5234 State Rt.63, Lebanon, OH 45036 | 2017-08-28 |
| 1407381528 | Kari Bump | Counselor | 320 E Silver St, Lebanon, OH 45036 | 2017-04-26 |
| 1154780435 | Ohio Department of Rehabilitation and Correction | Public Health or Welfare | State Route 63, Lebanon, OH 45036 | 2016-02-16 |
| Find all providers in zip 45036 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376028761 | Hyland Dental, PC | Clinic/Center | 367 Route 120 Bldg D, Lebanon, NH 03766-1430 | 2018-10-01 |
| 1831633122 | Acorn Dentistry for Kids - Lebanon, LLC | Clinic/Center | 1780 S Main St, Lebanon, OR 97355-3139 | 2016-12-06 |
| 1649438813 | Philip J. Cascione D.d.s. | Clinic/Center | 1125 N Lebanon St, Lebanon, IN 46052-1760 | 2008-05-23 |
| 1184849028 | Ditzler Family Dentistry PC | Clinic/Center | 850 Norman Dr, Lebanon, PA 17042-7444 | 2007-04-16 |
| 1851919534 | 42 North Dental Care, Pllc | Clinic/Center | 1 Court St Ste 270, Lebanon, NH 03766-6313 | 2020-07-09 |
| 1053946525 | Champion Dentistry, LLC | Clinic/Center | 322 N Maple St, Lebanon, TN 37087-2706 | 2020-03-05 |
| 1528585775 | Geoffrey W Blatter, Dmd, PC | Clinic/Center | 100 E Oak St, Lebanon, OR 97355-4135 | 2017-08-28 |
| 1467859231 | Michael L. Fellin, Dmd, LLC | Clinic/Center | 1695 N 7th St, Lebanon, PA 17046-2103 | 2014-11-22 |
| 1225440159 | Paul Nawiesniak Dds | Clinic/Center | 401 W Main St, Suite 101, Lebanon, TN 37087-3584 | 2014-05-27 |
| 1548601776 | Tosh Family Dental | Clinic/Center | 905 N Lebanon St, Lebanon, IN 46052-1725 | 2013-07-16 |
| Find all providers in LEBANON | ||||
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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.