C.J. Clark and Associates, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

C.J. CLARK AND ASSOCIATES, PC

Doing business as

Smiles On New Bern Avenue

Practice address

3110 New Bern Ave
Raleigh, NC 27610-1200

Phone

(252) 991-6843

NPI assigned

Jul 5, 2017

Last updated

Sep 11, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer King

Title

Operations Manager

Phone

(252) 991-6843

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Smiles On New Bern Avenue Doing business as

Locations

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

{
    "created_epoch": "1499212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505088000000",
    "number": "1619498268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 NASH ST NW STE E",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278961642",
            "telephone_number": "252-991-6843",
            "fax_number": "252-991-6854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101200",
            "telephone_number": "252-991-6843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C.J. CLARK AND ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-05",
        "last_updated": "2017-09-11",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "252-991-6843"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093880643",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smiles On New Bern Avenue",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2017; 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.