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DR. RANDOLPH LYNN CLARK DDS
NPI 1649347097
Dentist - General Practice in Edmond, OK

Active since November 29, 2006Opted out of Medicare · through Aug 21, 2026
301 S BOULEVARD ST, SUITE 118, EDMOND, OK 73034(405) 348-9182(405) 330-1677 Get Directions Write a Review

NPPES record last updated: December 26, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Randolph Lynn Clark Dds NPPES

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

DR. RANDOLPH LYNN CLARK DDS (NPI 1649347097) is an individual general practice provider in Edmond, Oklahoma, licensed in Oklahoma (OK4992) and active in the NPI registry since November 2006. He has opted out of Medicare through August 21, 2026 and remains eligible to order and refer.

NPPES Registry Identity

NPI1649347097
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. RANDOLPH LYNN CLARKCredential: DDS
Location Address301 S BOULEVARD ST, SUITE 118Edmond, OK 73034-3878
Mailing Address301 S Boulevard St, Suite 118Edmond, OK 73034-3878 · (405) 348-9182 · Fax (405) 330-1677
Phone(405) 348-9182
Fax(405) 330-1677
Sole ProprietorYes
Enumeration DateNovember 29, 2006
Last NPPES UpdateDecember 26, 2008
✔ NPI 1649347097 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in OK · OK4992
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.
301 S BOULEVARD ST, Edmond, OK 73034
Open in Google Maps ↗

Other Identifiers 1

Other73-137-9303OK · Federal Tax I.d

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Randolph Lynn Clark Dds 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 August 21, 2014 through August 21, 2026.

Opt-Out Effective DateAugust 21, 2014
Opt-Out In Effect ThroughAugust 21, 2026Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 73034 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
$82.46 typical visit price
range $53.00 – $162.61
Typical copayment $20.61 (range $13.25 – $40.65)
Most-billed visit code 99203
Established Patient
$66.48 typical visit price
range $16.68 – $132.40
Typical copayment $16.62 (range $4.17 – $33.10)
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.

LETS TALK KIDS
Clinic/Center (Hearing and Speech)
301 S BOULEVARD ST, SUITE 126
EDMOND, OK 73034
Oklahoma County (405) 471-5353
R. LYNN CLARK, D.D.S., P.C.
Dentist (General Practice)
301 S BOULEVARD ST
EDMOND, OK 73034
Oklahoma County (405) 348-9182
MRS. GRETA CARTER-FORCINA MA, CCC-SLP
Speech-Language Pathologist
301 S BOULEVARD ST, SUITE 126
EDMOND, OK 73034
Oklahoma County (405) 471-5353
SPEECH THERAPY PROFESSIONALS
Speech-Language Pathologist
301 S BOULEVARD ST, 126
EDMOND, OK 73034
Oklahoma County (405) 285-6765
MS. MARLA JEAN GALBRAITH MS CCC-SLP
Speech-Language Pathologist
301 S BOULEVARD ST
EDMOND, OK 73034
Oklahoma County (405) 285-6765
SPECTRUM THERAPY CENTER, CORP.
Specialist
301 S BOULEVARD ST, SUITE 126
EDMOND, OK 73034
Oklahoma County (405) 285-6765

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 Randolph Clark's NPI number?

The NPI number for Randolph Clark is 1649347097. It was assigned to this individual provider in the NPPES registry on November 29, 2006.

Where is Randolph Clark located?

Randolph Clark practices at 301 S Boulevard St Suite 118, Edmond, OK 73034. The listed phone number is (405) 348-9182.

What is Randolph Clark's specialty?

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

Is Randolph Clark enrolled in Medicare?

No. Randolph Clark has opted out of Medicare through August 21, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Randolph Clark accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Randolph 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 Randolph Clark was last updated on December 26, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.