Jennifer L. Clark, DDS, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DD4420 Issued in NM

Practice address

1279 E 1St Ave Ste D
Chico, CA 95926-1542

Phone

(530) 809-2379

NPI assigned

Oct 22, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1205189719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1279 E 1ST AVE STE D",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959261542",
            "telephone_number": "530-520-8401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1279 E 1ST AVE STE D",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959261542",
            "telephone_number": "530-809-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JENNIFER",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-22",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NM",
            "license": "DD4420",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "59915",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "DEN.00202055",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Correna Leann Clark
• Elizabeth Carol Clark
• Erika Leigh Clark
• Erin Elizabeth Clark, DPT, PT
• Jackson Lee Clark
• Melinda Anne Clark
• Sarah Clark
• Stevie Clark
• Bertram Louis Clarke, LVN
• David Eric Clarke, OD

• Periodontics in Chico, CA
• Providers in Chico, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.