Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

CORBIN ROSS CLARK
NPI 1215671334
Dentist - Oral and Maxillofacial Surgery in Nashville, TN

Q: What is Corbin Clark's NPI number?

The NPI number for Corbin Clark is 1215671334. It was assigned to this individual provider in the NPPES registry on April 25, 2022.

Q: What is Corbin Clark's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Q: Is Corbin Clark enrolled in Medicare?

No. Corbin Clark has opted out of Medicare through June 3, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Corbin Clark was last updated on August 5, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 57 days 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 April 25, 2022Opted out of Medicare · through Jun 3, 2028

2111 BELCOURT AVE STE 201, NASHVILLE, TN 37212(615) 322-2377 Get Directions Write a Review

NPPES record last updated: August 5, 2026. Verified against the NPPES registry weekly; last sync: September 27, 2026.

Record update history: Aug 5, 2026, Apr 25, 2022 (2 updates tracked since 2022).

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About Corbin Ross Clark NPPES

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

CORBIN ROSS CLARK (NPI 1215671334) is an individual oral and maxillofacial surgery provider in Nashville, Tennessee, licensed in Tennessee (12063) and active in the NPI registry since April 2022. He has opted out of Medicare through June 3, 2028.

NPPES Registry Identity

NPI1215671334

Entity TypeIndividualMale

Primary Taxonomy1223S0112X

Provider Legal NameCORBIN ROSS CLARK

Location Address2111 BELCOURT AVE STE 201Nashville, TN 37212-3540

Mailing Address9671 Wiltshire DrOoltewah, TN 37363-4885 · (209) 769-5473

Phone(615) 322-2377

Sole ProprietorNo

Enumeration DateApril 25, 2022

Last NPPES UpdateAugust 5, 20262 updates tracked since enumeration

NPPES CertifiedAugust 5, 2026

✔ NPI 1215671334 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in TN · 12063

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

2111 BELCOURT AVE STE 201, Nashville, TN 37212

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Corbin Ross Clark has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from June 3, 2026 through June 3, 2028.

Opt-Out Effective DateJune 3, 2026

Opt-Out In Effect ThroughJune 3, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 7

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

MADISON HOCKADAY DMD

Student in an Organized Health Care Education/Training Program