Taylor Clark, DDS in Kirtland, NM - Medicare Dentist Provider

Taylor Clark, DDS is a medicare enrolled "Dentist" provider in Kirtland, New Mexico. His current practice location is 3 Road 6523, Kirtland, New Mexico. You can reach out to his office (for appointments etc.) via phone at (505) 598-6800.

Taylor Clark is licensed to practice in Arizona (license number 6577) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1336155571.

Contact Information

	Taylor Clark, DDS
	3 Road 6523, Kirtland, NM 87417-9452
	(505) 598-6800
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Taylor Clark
Gender	Male
Speciality	Dentist
Location	3 Road 6523, Kirtland, New Mexico
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1336155571
Provider Enumeration Date: 07/31/2006
Last Update Date: 08/09/2011

Medicare PECOS Information:

PECOS PAC ID: 5193001014
Enrollment ID: I20170407000863

Medical Identifiers

Medical identifiers for Taylor Clark such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1336155571	NPI	-	NPPES
947963	Medicaid	AZ

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
122300000X	Dentist	6577 (Arizona)	Primary
122300000X	Dentist	3385 (New Mexico)	Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Taylor Clark allows following entities to bill medicare on his behalf.

Entity Name	Cibola General Hospital Corporation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1780677039 PECOS PAC ID: 7113935891 Enrollment ID: O20060323000127

Entity Name	Cibola General Hospital Corporation
Entity Type	Part A Provider - Critical Access Hospital
Entity Identifiers	NPI Number: 1780677039 PECOS PAC ID: 7113935891 Enrollment ID: O20071121000279

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Taylor Clark is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Taylor Clark, DDS 3 Road 6523, Kirtland, NM 87417-9452 Ph: (505) 598-6800	Taylor Clark, DDS 3 Road 6523, Kirtland, NM 87417-9452 Ph: (505) 598-6800

Reviews and Comments

Dentist in Kirtland, NM

Cody Burnell Coleman, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 3 County Road 6523, Kirtland, NM 87417 Phone: 505-598-6800
Dr. Jared Michael Southwell, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 3 Road 6523, Kirtland, NM 87417 Phone: 505-598-6800 Fax: 505-598-6830
Michael Darais, Dentist Medicare: Not Enrolled in Medicare Practice Location: 3 County Road 6523, Kirtland, NM 87417 Phone: 505-598-6800
Bruce Brondon Shaheen, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: #3 Cr 6523, Sundance Dental Care Of Kirtland, Kirtland, NM 87417 Phone: 505-598-6800 Fax: 505-598-6830
Dr. Chris John Giblette, D.M.D Dentist Medicare: Not Enrolled in Medicare Practice Location: #3 Cr 6523, Kirtland, NM 87417 Phone: 505-598-6800
Dr. Shaun Henderson, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 3 Road 6523, Kirtland, NM 87417 Phone: 505-598-6800

Taylor Clark, DDS - Medicare Dentist in Kirtland, NM