Jacqueline Clary, D.M.D, M.S.D.
Individual provider Active NPI Prosthodontics · Chippewa, WI
NPI 1497130512 · NPPES record last updated Aug 27, 2026
Key facts
- NPI
- 1497130512
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthodontics 1223P0700X
- License
- 30763 (TX)
- Practice address
- 850 Lakeland Drive
Chippewa, WI 54701 - Phone
- (715) 738-2000
- NPI assigned
- Jul 30, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160727001591 | WI | Order and Referring Only - Oral Surgery |
2961795075 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30763 | TX | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A & a Dental Clinic, P.C. | Prosthodontics | Past | Accepting new patients |
| A&a Dental Kids, PLLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 30763 | TX | Yes |
Addresses
Primary practice location
850 Lakeland Drive
Chippewa, WI 54701
Mailing address
1885 El Paseo St Apt 32307
Houston, TX 77054-3051
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.