MIRANDA CLARK (NPI# 1639658859) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639658859 |
| Entity Type | Individual |
| Full Name | MIRANDA CLARK |
| Credential | RDH |
| Practice Address |
1735 S Public Rd Ste 100 Lafayette CO 80026-7093 |
| Mailing Address |
1735 S Public Rd Ste 203 Lafayette CO 80026-7093 |
| Practice Telephone | 3036659310 |
| Practice Fax Number | 3036653397 |
| Mailing Telephone | 3036653036 |
| Mailing Fax Number | 3036653397 |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2020-05-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | DH.002025174 | CO | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477032175 | Miranda Lynn Clark | Social Worker | 69 East Hawley Rd, Hawley, MA 01339 | 2018-08-13 |
| 1174080873 | Miranda Clark | Licensed Vocational Nurse | 9846 Hwy 31 E, Tyler, TX 75705-2329 | 2019-02-28 |
| Street Address |
1735 S PUBLIC RD STE 100 |
| City | LAFAYETTE |
| State | CO |
| Zip Code | 80026-7093 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225025406 | Clinica Campesina Family Health Services | Clinic/Center | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2005-10-03 |
| 1265070569 | Cathy Wing Chan | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2019-12-17 |
| 1609333871 | Jordan Gerard Levandoski | Nurse Practitioner | 1735 S Public Rd Ste 100, Lafayette, CO 80026 | 2019-02-25 |
| 1265907406 | Ciani Kate Sosa | Nurse Practitioner | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2018-10-03 |
| 1750865838 | Chairel Thomas | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2018-09-24 |
| 1548705718 | Kalah Ross | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2016-12-27 |
| 1265982193 | Rachel Sobieck | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2016-10-04 |
| 1003361346 | Jessica Jensen | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2016-08-16 |
| 1972956431 | Cara Mcgee | Physician Assistant | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2016-07-20 |
| 1831570217 | Hollyanne Giffin | Social Worker | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2015-06-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528671690 | Julia Michele Colton | Occupational Therapist | 110 S. Roosevelt Ave, Lafayette, CO 80026 | 2020-08-28 |
| 1265045900 | Amber M. Roter | Social Worker | 588 N Us-287 Co, Suite 200, Lafayette, CO 80026 | 2020-08-24 |
| 1669008314 | Dr. Sunda Friedman Tebockhorst Psychologicl Services, Ltd | Clinic/Center | 588 N Hwy 287, Suite 200, Lafayette, CO 80026 | 2020-03-13 |
| 1659918910 | Emily Nicole Pearson | Behavior Technician | 961 Sandstone Circle, Lafayette, CO 80026 | 2019-12-05 |
| 1790320612 | Gs Campus Asc, LLC | Clinic/Center | Lafayette Surgery Center, 340 Exempla Circle, Suite #400, Lafayette, CO 80026 | 2019-11-14 |
| 1639711864 | Martina Christina Holzach | Student in an Organized Health Care Education/Training Program | 1455 Dixon Ave, Suite #300, Lafayette, CO 80026 | 2019-10-09 |
| 1104474055 | 2nd Star Counseling | Clinic/Center | 260 S. Public Rd, Lafayette, CO 80026 | 2019-09-03 |
| 1912460015 | Premier Eye Surgery Center of Colorado, LLC | Clinic/Center | 1050 W. South Boulder Road, Lafayette, CO 80026 | 2019-04-08 |
| 1144704883 | Nikole J Randolph | Nutritionist | 2770 Dagny Way Suite 210, Lafayette, CO 80026 | 2018-09-19 |
| 1609388842 | Claro Scientific Laboratories Corp | Clinical Medical Laboratory | 1408 Horizon Ave Ste 101, Lafayette, CO 80026 | 2017-10-27 |
| Find all providers in zip 80026 | ||||
| Taxonomy Code | 124Q00000X |
| Grouping | Dental Providers |
| Classification | Dental Hygienist |
| An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962035261 | Icboggan, Inc | Dental Hygienist | 3799 Mt Diablo Blvd Unit 200, Lafayette, CA 94549-3545 | 2020-02-15 |
| 1508428749 | Nina M Cachanosky | Dental Hygienist | 1735 S Public Rd Ste 101, Lafayette, CO 80026-7093 | 2019-07-08 |
| 1265070569 | Cathy Wing Chan | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2019-12-17 |
| 1750865838 | Chairel Thomas | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2018-09-24 |
| 1548705718 | Kalah Ross | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2016-12-27 |
| 1790237741 | Sarah Renfro | Dental Hygienist | 1285 Centaur Village Dr, Suite 200, Lafayette, CO 80026-1214 | 2016-10-25 |
| 1265982193 | Rachel Sobieck | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2016-10-04 |
| 1003361346 | Jessica Jensen | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2016-08-16 |
| 1114338852 | Criselda Sanchez | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2014-05-15 |
| 1649400235 | Sara Lynn Nolen | Dental Hygienist | 1735 S Public Rd Ste 100, Lafayette, CO 80026-7093 | 2009-07-17 |
| Find all providers in LAFAYETTE | ||||
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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.