Jev a. Clark, DMD, MD, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D10561 Issued in OR

Legal business name

JEV A. CLARK, DMD, MD, LLC

Practice address

120 Ramsgate SQ S Ste 110
Salem, OR 97302-5870

Phone

(503) 371-6000

NPI assigned

Apr 19, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Jev A Clark, DMD, MDNPI 1558622936

Title

Doctor

Phone

(503) 371-6000

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Clark Implant & Oral Surgery Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jev Clark

  • Oral and Maxillofacial Surgery (Dentist)
  • Salem, OR
  • NPI 1558622936
  NPD Authorized official
• Martin J. Mehr, D.D.S.

  • Oral and Maxillofacial Surgery (Dentist)
  • Salem, OR
  • NPI 1174520548
  NPD (past)

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524096000000",
    "number": "1831686468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 RAMSGATE SQ S STE 110",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973025870",
            "telephone_number": "503-371-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 RAMSGATE SQ S STE 110",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973025870",
            "telephone_number": "503-371-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEV A. CLARK, DMD, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-19",
        "last_updated": "2018-04-19",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JEV",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "503-371-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D10561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "MD176989",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "D10561",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark Implant & Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeremy Haider DMD PC
• Jeromy R. Dixson, DMD, LLC
• Charlotte Marie Jeskey, PHD
• Tamera Jessen-Iverson
• Celeste Jett
• Robin Michelle Jewett, P.A.-C
• Donna Louise Jezierski, MA
• Dagne Jima
• Ricardo Ernesto Jimenez Ibarra
• Patricia Maria Jimenez Mendez, MD

• Oral and Maxillofacial Surgery (Dentist) in Salem, OR
• Providers in Salem, OR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; 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.