Provider Demographics
NPI:1629319694
Name:CLARK, JAMIE CHAPMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:CHAPMAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NORTHRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-3399
Mailing Address - Country:US
Mailing Address - Phone:703-470-6610
Mailing Address - Fax:
Practice Address - Street 1:25 NORTHRIDGE LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-3399
Practice Address - Country:US
Practice Address - Phone:530-464-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR60360697122300000X
390200000X
VA0401414729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program