CARLY RENE' CLARK (NPI# 1760827356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760827356 |
| Entity Type | Individual |
| Full Name | CARLY RENE' CLARK |
| Credential | RDH, EP |
| Practice Address |
3324 N Arlington Pl Portland OR 97217-7204 |
| Practice Telephone | 5038875923 |
| Mailing Telephone | 5038875923 |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2013-05-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 125K00000X | Advanced Practice Dental Therapist | H5380 | OR | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518471697 | Carly Clark | Dietitian, Registered | 1267 Norberry Ct Apt 36, Cranberry Township, PA 16066-5117 | 2017-11-28 |
| 1790151256 | Carly Clark | Physical Therapy Assistant | 159 W 1st St, Oswego, NY 13126-2045 | 2015-08-18 |
| 1427436773 | Carly Clark | Dental Hygienist | 2828 Zuni St, Apt 110, Denver, CO 80211-4331 | 2015-05-07 |
| 1518106632 | Carly Ann Clark | Massage Therapist | 127 W 79th St, Suite 4, New York, NY 10024-6416 | 2009-02-12 |
| Street Address |
3324 N ARLINGTON PL |
| City | PORTLAND |
| State | OR |
| Zip Code | 97217-7204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326531666 | Working Class Medicine LLC | Clinic/Center | 2133 N. Willis Blvd, Studio D, Portland, OR 97217 | 2018-06-12 |
| 1235643602 | Autism Outreach of Oregon | Occupational Therapist | 10350 N Vancouver Way #1043, Portland, OR 97217 | 2017-11-21 |
| 1689183717 | Kai-uwe H. Hahn Dmd Dba Edelweiss Dental | Clinic/Center | 3503 N Lombard Street, Portland, OR 97217 | 2017-09-20 |
| 1407308125 | Occupational Health Centers of The Southwest, P.a. (tx) | Clinic/Center | 3449 N Anchor Street, Ste 300a, Portland, OR 97217 | 2016-10-28 |
| 1750740577 | Sheila Amoo | Adult Companion | 236 N Killingworth St. Apt.b104, Portland, OR 97217 | 2016-02-22 |
| 1801282199 | Justine Osborn | Specialist | 4310 N. Interstate Ave, Portland, OR 97217 | 2015-04-13 |
| 1578957742 | Paul Buck Md, Dds, PC | Clinic/Center | 3332 N Lombard St, Suite C, Portland, OR 97217 | 2015-03-25 |
| 1295158186 | Rebecca Bulleri | Massage Therapist | 5416 N. Maryland Ave, Portland, OR 97217 | 2014-01-28 |
| 1659793107 | Shellmire Unlimited, P.C. | Community/Behavioral Health | 4134 N Vancouver Avenue, Suite 102, Portland, OR 97217 | 2014-01-16 |
| 1417207994 | Sportland Acupuncture LLC | Acupuncturist | 1025 N Humboldt, Portland, OR 97217 | 2012-09-12 |
| Find all providers in zip 97217 | ||||
| Taxonomy Code | 125K00000X |
| Grouping | Dental Providers |
| Classification | Advanced Practice Dental Therapist |
| An Advanced Practice Dental Therapist is: (1) A dental therapist who has completed additional training beyond basic dental therapy education and provides dental services in accordance with state advanced practice dental therapist laws or statutes; or (2) A dental hygienist with a graduate degree in advanced dental therapy prepared for independent and interdependent decision making and direct accountability for clinical judgment across the dental health care continuum. The individual has been authorized by the relevant state board or a tribal entity to provide services under the remote supervision of a dentist. The functions of the advanced practice dental therapist vary based on the needs of the dentist, the educational preparation of the advanced practice dental therapist and state dental practice acts and regulations. |
| Notes: Source: Summarized from Minnesota Statute 150A.106. [7/1/2012: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679061584 | Vash Dental Mobile LLC | Advanced Practice Dental Therapist | 1405 Se 168th Pl, Portland, OR 97233-4409 | 2018-04-26 |
| 1871081778 | Vash Dental LLC | Advanced Practice Dental Therapist | 623 Ne 160th Ave, Portland, OR 97230-5702 | 2018-04-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891121117 | Trisha Marie Battaglia | Advanced Practice Dental Therapist | 16735 Leroy Ln, Oregon City, OR 97045-1183 | 2013-09-18 |
Please comment or provide details below to improve the information on CARLY RENE' 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.