DR. DORRANCE D CLARK DDS, MSD
NPI 1104907617
Dentist - Periodontics in Warren, MI

Q: What is Dorrance Clark's NPI number?

The NPI number for Dorrance Clark is 1104907617. It was assigned to this individual provider in the NPPES registry on October 18, 2006.

Q: What is Dorrance Clark's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Q: When was this NPI record last updated?

The NPPES record for Dorrance Clark was last updated on December 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 18, 2006PECOS Enrolled

2425 E 12 MILE RD, WARREN, MI 48092(586) 519-5977 Get Directions Write a Review

NPPES record last updated: December 18, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 18, 2025, Jul 25, 2024 (2 updates tracked since 2024).

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About Dr. Dorrance D Clark Dds, Msd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DORRANCE D CLARK DDS, MSD (NPI 1104907617) is an individual periodontics provider in Warren, Michigan, licensed in Michigan (2901018485) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104907617

Entity TypeIndividualMale

Primary Taxonomy1223P0300X

Provider Legal NameDR. DORRANCE D CLARKCredential: DDS, MSD

Location Address2425 E 12 MILE RDWarren, MI 48092-5667

Mailing Address2425 E 12 Mile RdWarren, MI 48092-5667 · (586) 519-5826

Phone(586) 519-5977

Sole ProprietorNo

Enumeration DateOctober 18, 2006

Last NPPES UpdateDecember 18, 20252 updates tracked since enumeration

NPPES CertifiedDecember 18, 2025

✔ NPI 1104907617 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers

Taxonomy Code1223P0300X

License✔ Licensed in MI · 2901018485

Definition

That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

2425 E 12 MILE RD, Warren, MI 48092

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Other Identifiers 3

Medicaid736499NC

OtherAZ0479180AZ · Bluecross Blueshield #

Medicaid736499AZ

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Dorrance D Clark Dds, Msd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 48092 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$90.76 typical visit price

range $58.04 – $177.36

Typical copayment $22.69 (range $14.51 – $44.34)

Most-billed visit code 99203

Established Patient

$72.38 typical visit price

range $18.32 – $143.49

Typical copayment $18.09 (range $4.58 – $35.87)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. AMRUTA MAHAJAN

Dentist (Endodontics)

2425 E 12 MILE RD
WARREN, MI 48092

Macomb County (586) 573-7334

DR. JONATHAN MILLER D.D.S.

Dentist (General Practice)

2425 E 12 MILE RD
WARREN, MI 48092

Macomb County (586) 558-6684

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dorrance Clark's NPI number?

The NPI number for Dorrance Clark is 1104907617. It was assigned to this individual provider in the NPPES registry on October 18, 2006.

Where is Dorrance Clark located?

Dorrance Clark practices at 2425 E 12 Mile Rd, Warren, MI 48092. The listed phone number is (586) 519-5977.

What is Dorrance Clark's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Is Dorrance Clark enrolled in Medicare?

Yes. Dorrance Clark is registered in the Medicare PECOS enrollment system.

What insurance does Dorrance Clark accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 7 other insurers list Dorrance Clark as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Dorrance Clark was last updated on December 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.