JILL A CLARK (NPI# 1922061936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922061936 |
| Entity Type | Individual |
| Full Name | JILL A CLARK |
| Other Name | JILL A CLARKE |
| Credential | RDH |
| Practice Address |
755 Scott Cir Bldg 559 Hickam Afb HI 96853-5399 |
| Mailing Address |
3776 Elm Dr Pearl City HI 96782-3912 |
| Practice Telephone | 8084486371 |
| Mailing Telephone | 8087440007 |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2012-08-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | 0402203160 | VA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922368075 | Jill M Clark | Speech-Language Pathologist | 147 Trailside Cir, Hiram, GA 30141-3277 | 2012-05-23 |
| 1861777096 | Jill B. Clark | Counselor | 5123 Old Plank Rd, Onondaga, MI 49264-9707 | 2011-10-19 |
| 1174850739 | Jill A Clark | Massage Therapist | 54 C Utica St., Hamilton, NY 13346 | 2009-11-03 |
| 1639351448 | Jill Page Clark | Occupational Therapy Assistant | 1500 Woodline Drive, Raleigh, NC 27603-5760 | 2007-12-04 |
| 1487179255 | Jill Anne Clark | Social Worker | 401 Broad Street, Johnstown, PA 15906 | 2017-08-13 |
| 1598118648 | Jill Clark | Social Worker | 255 Elk Dr Ste C, Burleson, TX 76028-8691 | 2016-07-13 |
| 1871852681 | Jill Clark | Counselor | 23250 Chagrin Blvd, Suite 425, Beachwood, OH 44122-5470 | 2012-05-14 |
| 1205133246 | Jill Clark | Pharmacist | 1156 Carter Rd, Owensboro, KY 42301-2644 | 2011-02-25 |
| 1407164353 | Jill M Clark | Chiropractor | 401 W Ontario St, Suite 100, Chicago, IL 60654-6957 | 2010-09-14 |
| 1295922052 | Jill Elisabeth Clark | Colon & Rectal Surgery | 1250 E 3900 S, Ste 320, Salt Lake City, UT 84124-1348 | 2007-09-26 |
| Street Address |
755 SCOTT CIR BLDG 559 |
| City | HICKAM AFB |
| State | HI |
| Zip Code | 96853-5399 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548241276 | John Cinco | Family Medicine | 755 Scott Cir, Sgh, Hickam Afb, HI 96853-5399 | 2005-11-09 |
| 1225415235 | Sonia Evoy | Registered Nurse | 755 Scott Cir, 15th Medical Group, Hickam Afb, HI 96853-5399 | 2015-04-28 |
| 1922492537 | Tina Hairston | Dental Hygienist | 755 Scott Cir, Hickam Afb, HI 96853-5399 | 2015-03-20 |
| 1629482062 | Tripler Army Medical Center | Military/U.S. Coast Guard Pharmacy | 755 Scott Cir, Hickam Afb, HI 96853-5399 | 2014-06-13 |
| 1740626126 | Tyler Garrett | Dentist | 755 Scott Cir, Hickam Afb, HI 96853-5399 | 2013-05-13 |
| 1639300312 | Cameron Modisette | Military Health Care Provider | 755 Scott Cir, Hickam Afb, HI 96853-5399 | 2009-07-29 |
| 1669623690 | Kenneth Raymond Bellisle | Pharmacist | 755 Scott Cir, 15th Medical Group, Hickam Afb, HI 96853-5399 | 2008-10-08 |
| 1952582009 | Hickam Afb 15th Mdg | Clinic/Center | 755 Scott Cir, 15th Med Group, Hickam Afb, HI 96853-5399 | 2007-11-16 |
| 1063692234 | Anthony Mark Hall | Counselor | 755 Scott Cir, Bldg 559, Hickam Afb, HI 96853-5399 | 2007-11-05 |
| 1073656856 | Woody Charles Baker | Dentist | 755 Scott Cir, 15 Mdg Sgd, Hickam Afb, HI 96853-5399 | 2007-02-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467884759 | Edward Joseph Tucholski Jr. | Dentist | 15 Mdg, 755 Scott Circle, Jbphh, HI 96853 | 2013-08-08 |
| 1922232230 | Angela Marie Alveo-forbes | Military Health Care Provider | 375 Mamiya St, Bldg 2140, Hickam Ab, HI 96853 | 2009-05-14 |
| 1205180783 | John-michael Fowler | Registered Nurse | 755 Scott Circle, Jbphh, HI 96853 | 2012-11-05 |
| 1811250442 | April A Bronowski | Physical Therapist | 755 Scott Circle, 15 Mdg, Joint Base Pearl Harbor Hickam, HI 96853 | 2012-06-19 |
| 1609812163 | Joyce Ann Raszewski | Nurse Practitioner | 755 Scott Circle, Jbphh/hickam, HI 96853 | 2006-06-22 |
| 1720068976 | Richard Dale Quintana | Family Medicine | 15th Medical Group, Hickam Afb, Honolulu, HI 96853 | 2006-01-21 |
| 1124262746 | John Craig Bright | Military Health Care Provider | 15mdos/sgomf 755 Scott Circle, Hickam Afb, HI 96853-3672 | 2009-04-27 |
| 1134759715 | David Maldonado Santiago | Military Health Care Provider | 590 Moffet St, Jbphh, HI 96853-5168 | 2020-01-22 |
| 1366427395 | Lisa Katherine Rivera | Pathology | 590 Moffet St, Bldg 4077, Joint Base Pearl Harbor-hickam, Honolulu, HI 96853-5168 | 2005-12-13 |
| 1619154572 | Hickam Fire Emergency Services | Case Management | 345 Mamiya Avenue, Hickam, HI 96853-5233 | 2008-01-23 |
| Find all providers in zip 96853 | ||||
| Taxonomy Code | 124Q00000X |
| Grouping | Dental Providers |
| Classification | Dental Hygienist |
| An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578923280 | Susan Tateishi | Dental Hygienist | 755 Scott Cir Ste 559, Hickam Afb, HI 96853-5399 | 2016-02-24 |
| 1922492537 | Tina Hairston | Dental Hygienist | 755 Scott Cir, Hickam Afb, HI 96853-5399 | 2015-03-20 |
| 1558687350 | Khara Maciel | Dental Hygienist | 755 Scott Circle, 15th Dental Flight, Hickam Afb, HI 96853-5399 | 2010-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245870526 | Ouida Searay Vaillancourt | Dental Hygienist | 339 Mongomery Ave, Honolulu, HI 96819 | 2020-01-14 |
| 1245877968 | Marissa Powers | Dental Hygienist | 2452 Tusitala St Apt 809, Honolulu, HI 96815-3125 | 2019-12-01 |
| 1760024525 | Barbara Ann Pfuhl | Dental Hygienist | 790 Manawai St Apt 103, Kapolei, HI 96707-4567 | 2019-10-14 |
| 1679115513 | Carla Uchima-toy | Dental Hygienist | 246 Aikahi Loop, Kailua, HI 96734-1645 | 2019-10-11 |
| 1972152528 | Andrea D Raskin | Dental Hygienist | Bldg 660 Mc Cornack Road, Schofield Barracks, HI 96857 | 2019-09-06 |
| 1720636509 | Britney Tumaneng | Dental Hygienist | 94-951 Hiapo St, Waipahu, HI 96797-2804 | 2019-08-26 |
| 1376190959 | Nicole Felice Bishop | Dental Hygienist | Bldg#678 Mccornack Road, Na Koa Dental Clinic, Schofield Barracks, HI 96857 | 2019-08-20 |
| 1124671870 | Laura Beth Iversen | Dental Hygienist | 91-226 Leleoi Pl, Ewa Beach, HI 96706-4642 | 2019-07-22 |
| 1932675212 | Dept. of Health-hi Developmental Disabilities H&cdsb (dental) | Dental Hygienist | 1700 Lanakila Ave Rm 203, Honolulu, HI 96817-2115 | 2018-10-15 |
| 1689048456 | Samantha Duncan | Dental Hygienist | 92-1492 Aliinui Dr # 605, Kapolei, HI 96707-4295 | 2015-11-17 |
| Find all providers with the same taxonomy | ||||
| City | HICKAM AFB |
| Zip Code | 96853 |
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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.