Kelly Clark DDS PC
Kelly Clark DDS PC is a healthcare organization registered as General Practice Dentistry in Decatur, IL, holding Type 2 (organization) NPI 1982839056 since 2009. The authorized official on file is Kelly Clark, Owner/President.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1982839056 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Kelly Clark DDS PC |
| Other name | <Unavail> |
| Practice address | 3737 US RT 36 E, Decatur, IL, 62521 |
| Phone | 2174232400 |
| Enumeration date | 2009-05-19 |
| Last updated in NPPES | 2009-05-19 |
Authorized official
| Name | Kelly Clark |
|---|---|
| Title | Owner/President |
| Phone | 2174232400 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 1223G0001X | General Practice Dentistry | Primary | 060009717 | IL |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073693883 | Other | IL | BLUE CROSS |
| 1700959020 | Other | IL | BLUE CROSS |
| 1801059100 | Other | IL | BLUE CROSS |
| 1942379458 | Other | IL | BLUE CROSS |
Copy-ready billing details
Provider: Kelly Clark DDS PC NPI: 1982839056 Taxonomy: 1223G0001X (General Practice Dentistry) Address: 3737 US RT 36 E, Decatur, IL, 62521
Verify this record
Cross-check NPI 1982839056 against the authoritative CMS record: view Kelly Clark DDS PC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
Where is Kelly Clark DDS PC located?
How current is this record?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2009-05-19.