LARRY CLARK
NPI 1174945919
Dentist - General Practice in Boscobel, WI

Q: What is Larry Clark's NPI number?

The NPI number for Larry Clark is 1174945919. It was assigned to this individual provider in the NPPES registry on January 14, 2014.

Q: What is Larry Clark's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Larry Clark was last updated on January 14, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years 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 January 14, 2014PECOS Enrolled

105 E BLUFF ST, BOSCOBEL, WI 53805(608) 375-4549 Get Directions Write a Review

NPPES record last updated: January 14, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Larry Clark NPPES

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

LARRY CLARK (NPI 1174945919) is an individual general practice provider in Boscobel, Wisconsin, licensed in Wisconsin (5001678) and active in the NPI registry since January 2014. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174945919

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameLARRY CLARK

Location Address105 E BLUFF STBoscobel, WI 53805-1610

Mailing Address105 E Bluff StBoscobel, WI 53805-1610 · (608) 375-4549

Phone(608) 375-4549

Sole ProprietorNo

Enumeration DateJanuary 14, 2014

✔ NPI 1174945919 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in WI · 5001678

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

105 E BLUFF ST, Boscobel, WI 53805

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Larry Clark 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 53805 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

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

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 6

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

MARIAH M MAYNE RDH

Dental Hygienist