BENNIE CLARK JR DMD PA (NPI# 1295023752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295023752 |
| Entity Type | Organization |
| Organization Name | BENNIE CLARK JR DMD PA |
| Other Organization Name | SOUTEL DENTAL CENTER II |
| Practice Address |
5475 Soutel Dr Jacksonville FL 32219-3464 |
| Practice Telephone | 9047644576 |
| Practice Fax Number | 9047229900 |
| Mailing Telephone | 9047644576 |
| Mailing Fax Number | 9047222200 |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2019-11-01 |
| Authorized Official Name | DR. LORRAINE POLITE CLARK (VICE PRESIDENT) |
| Authorized Official Telephone | 9047222200 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 124Q00000X | Dental Hygienist | Dental Providers | ||
| Y | 122300000X | Dentist | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 071395300 | 05 |
| Other Name | Type Code |
|---|---|
| Soutel Dental Center II | Doing Business As Name - Organization |
| Today's Dentistry | Other Name - Individual/Organization |
| Street Address |
5475 SOUTEL DR |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32219-3464 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467475129 | Lorraine Polite Clark | Dentist | 5475 Soutel Dr, Jacksonville, FL 32219-3464 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902182447 | Beatrice E Hall | Technician | 5838 Soutel Dr., Jacksonville, FL 32219 | 2011-10-28 |
| 1437173697 | Bennie Clark Jr. | Dentist | 5475 Soutel Drive, Jacksonville, FL 32219 | 2006-07-27 |
| 1801842679 | Susan E. Kurner | Counselor | 10149 Fox Lake Ct, Jacksonville, FL 32219-1693 | 2006-05-25 |
| 1841629243 | Latonia Delores Simmons | Day Training, Developmentally Disabled Services | 12428 Cadley Cir, Jacksonville, FL 32219-1861 | 2013-11-06 |
| 1114495512 | La Assistant Services | Home Health Aide | 12428 Cadley Cir, Jacksonville, FL 32219-1861 | 2018-11-05 |
| 1831759141 | Stephanie R Forde | Technician | 12379 Glimmer Way, Jacksonville, FL 32219-1867 | 2019-06-18 |
| 1700372869 | Valerie M Vinson-anderson | In Home Supportive Care | 6751 Langford St, Jacksonville, FL 32219-1875 | 2018-07-02 |
| 1821528860 | Samaiyah Harris | Adult Companion | 6967 Sandle Dr, Jacksonville, FL 32219-1884 | 2017-06-13 |
| 1023508595 | Present Help Companion Services, LLC | Respite Care | 6967 Sandle Dr, Jacksonville, FL 32219-1884 | 2018-05-10 |
| 1629635420 | Kimberly Walker | Registered Nurse | 8921 Merseyside Ave, Jacksonville, FL 32219-2374 | 2019-05-28 |
| Find all providers in zip 32219 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902419864 | Andre M Fang | Dentist | 6801 Roosevelt Blvd, Jacksonville, FL 32212-1192 | 2020-08-28 |
| 1952911752 | Jeff Woohyeok Chang | Dentist | 964 Ajax Street, Jacksonville, FL 32212 | 2020-08-06 |
| 1093323479 | Britney Marie Cruz | Dentist | 1280 Western Blvd Unit 200, Jacksonville, NC 28546-7658 | 2020-07-21 |
| 1083238786 | Sleep Better Solutions LLC | Dentist | 4215 Southpoint Blvd Ste 240, Jacksonville, FL 32216-0932 | 2020-05-29 |
| 1114550258 | James Moran | Dentist | 7990 Baymeadows Rd E # 718, Jacksonville, FL 32256-2961 | 2020-02-18 |
| 1265075329 | Latoya Goins | Dentist | 1280 Western Blvd, Jacksonville, NC 28546-6653 | 2019-10-22 |
| 1437706462 | Stephanie Marquez | Dentist | 751 Oak St Ste 601, Jacksonville, FL 32204-3373 | 2019-08-23 |
| 1831751064 | Rachel Marie Schloth | Dentist | 12086 Fort Caroline Rd Ste 105, Jacksonville, FL 32225-2688 | 2019-07-09 |
| 1598324113 | Dhaval Yogeshkumar Shah | Dentist | 8206 Philips Hwy., Suite 21, Jacksonville, FL 32256 | 2019-06-07 |
| 1235796954 | Carolina Garcia | Dentist | 790 Skymarks Dr Ste 109, Jacksonville, FL 32218-7267 | 2019-05-29 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32219 |
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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.