Jill A Clark, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

0402203160 Issued in VA

Practice address

755 Scott Cir
BLDG 559
Hickam Afb, HI 96853-5399

Phone

(808) 448-6371

NPI assigned

Apr 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jill A Clarke Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344211200000",
    "number": "1922061936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3776 ELM DR",
            "city": "PEARL CITY",
            "state": "HI",
            "postal_code": "967823912",
            "telephone_number": "808-744-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 SCOTT CIR",
            "address_2": "BLDG 559",
            "city": "HICKAM AFB",
            "state": "HI",
            "postal_code": "968535399",
            "telephone_number": "808-448-6371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "JILL",
        "middle_name": "A",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-10",
        "last_updated": "2012-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "VA",
            "license": "0402203160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "CLARKE",
            "middle_name": "A",
            "credential": "RDH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lucas Gil Borg, DDS
• John Craig Bright, IDMT
• Michael E Brown II, CADC
• Henry L. Cashen, L.C.S.W.
• John Cinco, M.D
• Taneyea Ryaona Cooley, LCSW
• Sarah Fox
• Tyler Garrett, D.M.D.
• Caitlin Rose Guthrie, DPT
• Tina Hairston

• Dental Hygienist in Hickam Afb, HI
• Providers in Hickam Afb, HI by specialty
• Dental Hygienist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2012; 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.