Individual provider Active NPI

Jessica Ann Mellin, DMD

  • General Practice Dentistry
  • Clovis, NM
National Provider Identifier
1366328619
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DB-2025-0244 Issued in NM
Practice address
600 Texas St
Clovis, NM 88101-9410
Phone
(575) 762-1900
NPI assigned
Aug 13, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 11109 SC
General Practice Dentistry 1223G0001X DB-2025-0244 NM Primary

Addresses

Primary practice location

600 Texas St
Clovis, NM 88101-9410

Mailing address

600 Texas St Ste C
Clovis, NM 88101-9410
Phone (575) 762-1900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251118001365 NM Order and Referring Only - DentistPractitioner - Dentist 2466943436

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DB-2025-0244NMMDGeneral Practice Dentistry
11109SCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Kidskare P.C. General Practice PastSince Oct 5, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1755043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1366328619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 TEXAS ST STE C",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019410",
            "telephone_number": "575-762-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 TEXAS ST",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "881019410",
            "telephone_number": "575-762-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELLIN",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-13",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "11109",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DB-2025-0244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, NM

Sources for this page

Verify at the official NPI Registry.