Jay Regan Clark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7663 Issued in WA

Practice address

20 S Pines Rd
Spokane Valley, WA 99206-5136

Phone

(509) 891-5299

Fax

(509) 891-6852

NPI assigned

Nov 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1457424434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 S PINES RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992065136",
            "telephone_number": "509-891-5299",
            "fax_number": "509-891-6852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 S PINES RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992065136",
            "telephone_number": "509-891-5299",
            "fax_number": "509-891-6852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JAY",
        "middle_name": "REGAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "7663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5024112",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carin M Chynoweth, PTA
• Paden Cipolla-Crane
• Becky Ann Clark, B.S., P.T.
• Erin A Clark
• Isabella Kae Clark, RN
• Jessica Blanche Clark, LMT
• Rebecca June Clark, LMP
• Stacey K Clark, M.D.
• Tina Marie Clark
• Tyler Clark

• General Practice Dentistry in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.