DR. JERRY CARL CLARKE (NPI# 1356567010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356567010 |
| Entity Type | Individual |
| Full Name | DR. JERRY CARL CLARKE |
| Credential | DDS |
| Practice Address |
2490 Pruden Blvd Suffolk VA 23434-4206 |
| Mailing Address |
510 Cavalier Dr Virginia Beach VA 23451-3834 |
| Practice Telephone | 7575399398 |
| Practice Fax Number | 7575399492 |
| Mailing Telephone | 7574283477 |
| Mailing Fax Number | 7574283477 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
3823 | VA | Dental Providers |
| Street Address |
2490 PRUDEN BLVD |
| City | SUFFOLK |
| State | VA |
| Zip Code | 23434-4206 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033505193 | Robert Anderson | Dentist | 2490 Pruden Blvd, Suffolk, VA 23434-4206 | 2015-04-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235780255 | Chiquita Savage | Home Health | You 1st Healthcare, 112 West Washington Street Suite 502, Suffolk, VA 23434 | 2019-09-20 |
| 1912561713 | Revivication Counseling Services | Counselor | 814 Cripple Creek Lane, Suffolk, VA 23434 | 2019-04-26 |
| 1558826958 | Nita Jenkins | Non-emergency Medical Transport (VAN) | 707 Gittings St. Suite 105, Suffolk, VA 23434 | 2019-02-10 |
| 1730660952 | Latrese L Riddick | Driver | 418 Jackson St, Suffolk, VA 23434 | 2018-08-25 |
| 1114411279 | Percilla D Zeno | Community Health Worker | 102 Niblick Cir, Suffolk, VA 23434 | 2018-06-21 |
| 1437652765 | Aprele Gaddie | Health Educator | 2769 Godwin Boulevard, Suffolk, VA 23434 | 2018-03-13 |
| 1598284283 | Domonic Teheran Scott | Driver | 102 Brewer Ave, Suffolk, VA 23434 | 2017-09-13 |
| 1578089397 | Nakia Shantel Francis | Nurse Practitioner | 2970 Godwin Blvd, Suite 320, Suffolk, VA 23434 | 2017-08-15 |
| 1679093009 | Daisy Mae Aba, LLC | Behavioral Analyst | 3212 Clearcreek Rd., Suffolk, VA 23434 | 2017-06-27 |
| 1114457736 | Better Care Family Homes | Day Training, Developmentally Disabled Services | 813 West Washington Street, Suffolk, VA 23434 | 2017-06-15 |
| Find all providers in zip 23434 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497361471 | Lisa A. Marvil, D.m.d., P.l.l.c. | Dentist | 17341-b Pickwick Drive, Purcellville, VA 20132 | 2020-09-16 |
| 1720624307 | Deena Hadithi Dmd, PC. | Dentist | 7210 Old Keene Mill Rd Ste 3, Springfield, VA 22150-3442 | 2019-11-19 |
| 1689223836 | Alka Panwar | Dentist | 4319 Dale Blvd Ste 6, Woodbridge, VA 22193-2401 | 2019-09-10 |
| 1801445135 | Neha Agarwal | Dentist | 23386 Epperson Sq, Brambleton, VA 20148-5794 | 2019-09-09 |
| 1164999181 | Smba Dentistry, Pllc | Dentist | 2801 Mcrae Rd Ste C1, North Chesterfield, VA 23235-3056 | 2018-10-29 |
| 1750860516 | Khashayar Kordbacheh Changi | Dentist | 3543 W Braddock Rd Ste E2, Alexandria, VA 22302-1903 | 2018-08-11 |
| 1205314309 | Shivangi B Amin | Dentist | 2420 Old Brick Rd Apt 1315, Glen Allen, VA 23060-5995 | 2018-07-31 |
| 1881107100 | New River Periodontics and Dental Implant Center, PC | Dentist | 2612 Sheffield Drive, Blacksburg, VA 24060 | 2017-11-08 |
| 1740793355 | Amy Ton Dds Pllc | Dentist | 11868 Sunrise Valley Dr Ste 100, Reston, VA 20191-3320 | 2017-11-06 |
| 1023539301 | Denver James Lyons | Dentist | 521 N 11th St # 980566, Richmond, VA 23298-5045 | 2017-06-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.