Active NPI
Tina Marie Clark
- Dental Assistant
- Portsmouth, OH
National Provider Identifier
1790460814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 51.015003
- Practice address
- 1539 Jackson St
Portsmouth, OH 45662-4480 - Phone
- (740) 981-6276
- NPI assigned
- Jun 16, 2023
- 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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 51.015003 | OH | Primary |
Addresses
Primary practice location
1539 Jackson St
Portsmouth, OH 45662-4480
Mailing address
VA Medical Center
17273 State Route 104
Chillicothe, OH 45601-0999
Phone (740) 773-1141
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 |
|---|---|---|---|
| 51.015003 | OH | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686873600000",
"number": "1790460814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "VA MEDICAL CENTER",
"address_2": "17273 STATE ROUTE 104",
"city": "CHILLICOTHE",
"state": "OH",
"postal_code": "456010999",
"telephone_number": "740-773-1141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1539 JACKSON ST",
"city": "PORTSMOUTH",
"state": "OH",
"postal_code": "456624480",
"telephone_number": "740-981-6276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "TINA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-16",
"last_updated": "2023-06-16",
"certification_date": "2023-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "OH",
"license": "51.015003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portsmouth, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.