BENNIE CLARK JR. (NPI# 1437173697) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437173697 |
| Entity Type | Individual |
| Full Name | BENNIE CLARK JR. |
| Credential | DMD |
| Practice Address |
5475 Soutel Drive Jacksonville FL 32219 |
| Practice Telephone | 9047644576 |
| Practice Fax Number | 9047667021 |
| Mailing Telephone | 9047644576 |
| Mailing Fax Number | 9047667021 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DN14137 | FL | Dental Providers |
| Street Address |
5475 SOUTEL DRIVE |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32219 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902182447 | Beatrice E Hall | Technician | 5838 Soutel Dr., Jacksonville, FL 32219 | 2011-10-28 |
| 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 |
| 1649808197 | Leaanne Griffis | Registered Nurse | 10482 New Kings Rd, Jacksonville, FL 32219-2418 | 2020-03-31 |
| Find all providers in zip 32219 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962018424 | Sydney Fowler | Dentist | 12276 San Jose Blvd Ste 314, Jacksonville, FL 32223-8632 | 2020-09-21 |
| 1871106260 | Comfortable Care Dental Health Professionals, P.a. | Dentist | 4445 Town Center Pkwy, Jacksonville, FL 32246-8565 | 2020-08-26 |
| 1831710771 | Mark William Russell | Dentist | 461 Western Blvd Ste 104, Jacksonville, NC 28546-7637 | 2020-05-01 |
| 1205476496 | Point Meadows Dental Center, Inc. | Dentist | 10915 Baymeadows Rd, #106, Jacksonville, FL 32256 | 2020-01-15 |
| 1659923118 | San Jose Aspen Pllc | Dentist | 10502 San Jose Blvd Ste B, Jacksonville, FL 32257-6209 | 2019-07-15 |
| 1326603176 | Evens Family Dental | Dentist | 13107 Atlantic Blvd, Jacksonville, FL 32225-7127 | 2019-05-07 |
| 1487123006 | Susan Prater Kudlats, D.m.d, P.a. | Dentist | 12620 Beach Blvd Ste 18, Jacksonville, FL 32246-7130 | 2018-11-14 |
| 1043792534 | Atlantic Dentistry Pa | Dentist | 13474 Atlantic Blvd Ste 109, Jacksonville, FL 32225-0100 | 2018-08-31 |
| 1447738620 | Argyle Dental Pllc | Dentist | 6001 Argyle Forest Blvd Ste 4, Jacksonville, FL 32244-6127 | 2018-07-31 |
| 1427534445 | Sandeep Chunduru | Dentist | 571 Yopp Rd Ste 308, Jacksonville, NC 28540-3683 | 2018-07-12 |
| 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.