Active NPI
Jessica Michelle Clark, D.D.S.
- Pediatric Dentistry
- Virginia Beach, VA
National Provider Identifier
1760794309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 6911
- Practice address
- 1300 Kempsville Rd Ste 5
Virginia Beach, VA 23464-6199 - Phone
- (757) 467-7797
- NPI assigned
- Jul 12, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 6911 | SC | Primary |
Addresses
Primary practice location
1300 Kempsville Rd Ste 5
Virginia Beach, VA 23464-6199
Mailing address
1300 Kempsville Rd Ste 5
Virginia Beach, VA 23464-6199
Phone (757) 467-7797
Other names 1
- Dr. Jessica Michlle Clark
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6911 | SC | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509926400000",
"number": "1760794309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 KEMPSVILLE RD STE 5",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234646199",
"telephone_number": "757-467-7797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 KEMPSVILLE RD STE 5",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234646199",
"telephone_number": "757-467-7797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JESSICA",
"middle_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-12",
"last_updated": "2017-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "SC",
"license": "6911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "CLARK",
"middle_name": "MICHLLE",
"prefix": "DR.",
"credential": "DDS",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.