Active NPI
Jay Allen Clark, DDS
- Dentist
- Richfield, MN
National Provider Identifier
1669488904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10110
- Practice address
- 7104 Chicago Ave
Richfield, MN 55423-3301 - Phone
- (612) 869-3239
- Fax
- (612) 866-7011
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10110 | MN | Primary |
Addresses
Primary practice location
7104 Chicago Ave
Richfield, MN 55423-3301
Mailing address
7104 Chicago Ave
Richfield, MN 55423-3301
Phone (612) 869-3239
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Corner Family Clinic LLC | Past | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669488904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7104 CHICAGO AVE",
"city": "RICHFIELD",
"state": "MN",
"postal_code": "554233301",
"telephone_number": "612-869-3239",
"fax_number": "612-866-7011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7104 CHICAGO AVE",
"city": "RICHFIELD",
"state": "MN",
"postal_code": "554233301",
"telephone_number": "612-869-3239",
"fax_number": "612-866-7011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JAY",
"middle_name": "ALLEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "10110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richfield, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.