What is Charlie Clark's NPI number?

Charlie Clark's National Provider Identifier (NPI) is 1417103482, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.

What is Charlie Clark's specialty?

Charlie Clark is listed in the NPPES registry with a primary specialty of Dentist (Dental Providers).

Where is Charlie Clark located?

Charlie Clark's practice location on file with NPPES is 15264 W Brookside Ln, Surprise, AZ 85374-3989.

What is Charlie Clark's phone number?

The practice phone number listed in the NPPES registry for Charlie Clark is (623) 474-3975.

Is Charlie Clark's NPI active?

Yes — Charlie Clark's NPI (1417103482) is active in the NPPES registry as of the last update on 2009-08-04.

IndividualActive

Charlie Clark, DMD

NPI 1417103482 · Dentist · Surprise, AZ

Charlie Clark, DMD is a Dentist provider in Surprise, AZ (NPI 1417103482).

Provider details

NPI number: 1417103482
Entity type: Individual
Primary specialty: DentistDental Providers
Credential: DMD
Sex: Male
Sole proprietor: No
License: D7793 (AZ)

Specialties & taxonomies

DentistPrimary122300000XLicense D7793 (AZ)
Dental Providers
Dentist122300000XLicense 6303-15 (WI)
Dental Providers

Profile Score

Detailed profile(87/100 index)

A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.

Registry tenure38% of score
17 yrs in NPPES registry
Profile completeness38% of score
100% of core fields populated
Practice footprint23% of score
1 documented practice location

Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.

Practice location

15264 W Brookside Ln

Surprise, AZ 85374-3989

Phone: (623) 474-3975

Fax: (623) 474-3198

Street-level locationGet directions

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Mailing address