DR. KENNETH CLARK (NPI# 1619336229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1619336229 |
Entity Type | Individual |
Full Name | DR. KENNETH CLARK |
Credential | D.D.S. |
Practice Address |
2524 Hillside Heights Dr Green Bay WI 54311-6777 |
Practice Telephone | 9202466118 |
Mailing Telephone | 9202466118 |
Enumeration Date | 2016-02-11 |
Last Update Date | 2016-02-11 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 1223E0200X |
Dentist Specialization: Endodontics |
3707-15 | WI | Dental Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1275056889 | Kenneth Clark | Hearing Instrument Specialist | 304 E Broadway St Ste 20, Mount Pleasant, MI 48858-2364 | 2017-07-25 |
1063887834 | Kenneth Eugene Clark | Occupational Therapy Assistant | 4885 Eldon Dr S, Colorado Springs, CO 80916-4431 | 2015-12-04 |
1821119959 | Kenneth R Clark | Pharmacist | 4211 Hospital St Ste 104, Pascagoula, MS 39581-5310 | 2007-04-03 |
1104487149 | Kenneth John Clark | Hearing Instrument Specialist | 462 Roosevelt Rd, Glen Ellyn, IL 60137-5611 | 2019-06-20 |
1144740580 | Kenneth John Clark Jr. | Physical Therapist | 6119 Deltona Blvd, Spring Hill, FL 34606-1011 | 2017-06-27 |
1669878443 | Kenneth Clark | Registered Nurse | 724 N Charlotte St, Pottstown, PA 19464-4607 | 2014-11-06 |
1598046401 | Kenneth Dale Clark | Orthotist | 9303 Pinecroft Dr, The Woodlands, TX 77380-3181 | 2011-09-06 |
1093012783 | Kenneth Howard Clark | Pathology | 200 Lothrop St, Pittsburgh, PA 15213-2536 | 2011-02-16 |
1568794725 | Kenneth Andrew Clark II | Marriage & Family Therapist | 10800 Financial Centre Pkwy Ste 290, Little Rock, AR 72211-3581 | 2010-02-12 |
1942344031 | Kenneth L Clark | Registered Nurse | 2640 Breslauer Way, Redding, CA 96001-4246 | 2007-02-20 |
Street Address |
2524 HILLSIDE HEIGHTS DR |
City | GREEN BAY |
State | WI |
Zip Code | 54311-6777 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639568603 | Kenneth C. Clark Dds,ms | Clinic/Center | 2524 Hillside Heights Dr, Green Bay, WI 54311-6777 | 2015-01-14 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1295333847 | Karen Ginnow | Pharmacist | Walmart #1908, 2292 Main St, Green Bay, WI 54311 | 2020-10-15 |
1639786551 | Maggie Hall | Dental Hygienist | 2633 Development Dr. Ste 40, Green Bay, WI 54311 | 2020-09-24 |
1295370807 | Jennifer Marie Arendt | Technician | 2970 Mossy Oak Cir #39, Green Bay, WI 54311 | 2019-11-07 |
1518508803 | Cheryl Ann Johnson | Specialist | 830 Edgewood Dr., Green Bay, WI 54311 | 2019-10-08 |
1124670898 | Robert H Wagner Family Dentist S.c. | Dentist | 2830 Curry Court, Suite 1, Green Bay, WI 54311 | 2019-07-12 |
1821659624 | The Salvation Army | Counselor | The Salvation Army Ray & Joan Kroc Center, 1315 Lime Kiln Road, Green Bay, WI 54311 | 2019-06-24 |
1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
1861916769 | Atlas Spinal Care | Chiropractor | 2069 Central Ct, Suite 11, Green Bay, WI 54311 | 2017-08-01 |
1851844161 | Green Bay Family Dental LLC | Dentist | 2609 Development Dr., Green Bay, WI 54311 | 2016-08-03 |
1710382809 | Betsy Hoida | Pharmacist | 2485 Greenbrier Rd., Green Bay, WI 54311 | 2014-10-31 |
Find all providers in zip 54311 |
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 |
---|---|---|---|---|
1801008818 | Thomas Jens Witek | Dentist | 2581 Development Drive, Suite 202, Green Bay, WI 54311 | 2007-05-03 |
1689727729 | John Graham Newman | Dentist | 1537 Park Pl Ste 300, Green Bay, WI 54304-1986 | 2007-01-20 |
1881608974 | Andrew R Lulloff | Dentist | 2353 S Ridge Rd, Green Bay, WI 54304-5069 | 2006-07-27 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1164031464 | Central Wisconsin Endodontic Specialists LLC | Dentist | 2606 Stewart Avenue, #102, Wausau, WI 54401 | 2020-07-23 |
1891319273 | Janesville Endodontics | Dentist | 1616 N Randall Ave Ste 180, Janesville, WI 53545-1155 | 2020-06-02 |
1306480918 | Teng Kai Ong | Dentist | 1801 West Wisconsin Ave., Milwaukee, WI 53233 | 2019-11-06 |
1215344478 | Helen Tsao | Dentist | 2606 Stewart Ave, Ste 102, Wausau, WI 54401-5502 | 2014-07-18 |
1275973166 | Meridian Endodontics and Periodontics | Dentist | 20350 Water Tower Blvd Ste 203, Brookfield, WI 53045-3558 | 2013-06-25 |
1447698451 | Eva C Dahl | Dentist | 2700 National Dr Ste 1, Onalaska, WI 54650-6708 | 2013-06-12 |
1275873374 | F Kris Olsen | Dentist | 1320 S Green Bay Road, Racine Dental Group, Racine, WI 53406 | 2013-02-26 |
1063710655 | Erik Daniel Deyoung | Dentist | 6100 W State St, Apt. 636, Wauwatosa, WI 53213-2983 | 2011-03-05 |
1376786285 | Ronald David Meyers | Dentist | 2600 N Mayfair Rd Ste 240, Wauwatosa, WI 53226-1309 | 2009-04-08 |
1942450457 | Wisconsin Endodontic Group, S.c. | Dentist | 2600 N. Mayfair Rd., Ste 240, Wauwatosa, WI 53226 | 2008-09-22 |
Find all providers with the same taxonomy |
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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.