Bennie Clark Jr Dmd PA
Dentist in Jacksonville, FL. Organization (NPI-2).
NPI number1295023752
StatusActive
Last updated in NPPESNov 1, 2019
Details
- NPI
- 1295023752
- Entity type
- Organization (NPI-2)
- Legal business name
- Bennie Clark Jr Dmd PA
- Organization subpart
- No
- Enumeration date
- Jul 19, 2011
- Last updated
- Nov 1, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | – | – | Yes |
| 124Q00000X | Dental Hygienist | – | – |
Other names
- Soutel Dental Center II (Doing Business As)
Practice location
5475 Soutel DrJacksonville, FL 32219-3464
Phone 904-764-4576 · Fax 904-722-9900
Mailing address
5475 Soutel DrJacksonville, FL 32219-3464
Phone 904-764-4576 · Fax 904-722-2200
Authorized official
Lorraine Polite Clark
Vice President
9047222200
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