NPIMap

Organization Active NPI

Jessica M. Clark, DDS, P.C.

  • Pediatric Dentistry
  • Virginia Beach, VA
National Provider Identifier
1902261233
Registry record updated Dec 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
0401414334 Issued in VA
Legal business name
JESSICA M. CLARK, DDS, P.C.
Practice address
1300 Kempsville Rd Ste 5
Virginia Beach, VA 23464-6199
Phone
(757) 467-7797
NPI assigned
Dec 31, 2015
Last updated
Dec 31, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2015

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

Authorized official

Name
Jessica M. Clark, DDSNPI 1760794309
Title
Owner
Phone
(757) 467-7797

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 0401414334 VA 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

National Provider Directory

National Provider Directory

Locations

1300 Kempsville Rd
Ste 5
Virginia Beach, VA 23464
Phone (757) 467-7797

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1451520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451520000000",
    "number": "1902261233",
    "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",
            "fax_number": "757-474-1493"
        },
        {
            "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": {
        "organization_name": "JESSICA M. CLARK, DDS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-31",
        "last_updated": "2015-12-31",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-467-7797",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401414334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Dec 31, 2015; 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.