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Active NPI 1942379458 Individual Practitioner Male Practitioner

Dr. Kelly Clark , DDS

Dentist - General Practice • Decatur, IL

Public Directory Information & Medical Disclaimer

This profile is compiled from official public domain records provided by CMS and the NPPES registry. TRUE-MEDINFO is an independent reference directory and does not provide medical advice, diagnosis, or treatment recommendations. Always consult a licensed medical professional for personal health decisions.

Professional Overview & Biography Verified Profile Summary

Dr. Kelly Clark, DDS is a registered healthcare professional specializing in Dentist - General Practice in Decatur, IL. Official NPI practice address is registered at 3737 E RTE 36.

Practice Location & Contact Primary Location

Practice Address

3737 E Rte 36

Decatur, IL 625215028

Telephone 2174232400
Fax 2174232460
Associated Practice Facility / Clinic
🏢 Kelly Clark Dds Pc Facility NPI 1982839056

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Decatur, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
22 Specialists

Practicing in Decatur, IL (5581 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-06-15
Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License IL 019026315

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
NPI 1073693883

Doctor of Dental Surgery

NPI 1700959020

Doctor of Dental Medicine

NPI 1801059100

Doctor of Dental Medicine

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Business Mailing Address June 15, 2026

Registered at 3737 E ROUTE 36, DECATUR, IL 62521 (Tel: 2174232400)

👤
Provider Name / Credentials Updated June 15, 2026

Recorded as KELLY CLARK, DDS

NPI Profile Active April 21, 2010

NPI status registered as active in NPPES database

📍
Updated Practice Location April 21, 2010

Registered at 3737 E RTE 36, DECATUR, IL 625215028 (Tel: 2174232400)

📍
Updated Business Mailing Address April 21, 2010

Registered at 1710 BRENTWOOD DR, MT ZION, IL 625491183

👤
Provider Name / Credentials Updated April 21, 2010

Recorded as KELLY CLARK

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 21, 2010

Dentist (License #019026315 in IL)

🟢
Initial NPI Registration & Enumeration November 07, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1942379458
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 07, 2006
Last Update: June 15, 2026
Sole Proprietor: No

Mailing Address

3737 E Route 36

Decatur, IL 62521

Phone: 2174232400

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.