Provider Demographics
NPI:1124240023
Name:JAMES D. CLARK, DDS, APC
Entity type:Organization
Organization Name:JAMES D. CLARK, DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-830-4101
Mailing Address - Street 1:26302 LA PAZ RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5313
Mailing Address - Country:US
Mailing Address - Phone:949-830-4101
Mailing Address - Fax:949-830-0741
Practice Address - Street 1:26302 LA PAZ RD
Practice Address - Street 2:202
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5313
Practice Address - Country:US
Practice Address - Phone:949-830-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty