Individual
BENNIE CLARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5475 SOUTEL DRIVE, JACKSONVILLE, FL 32219
(904) 764-4576
(904) 766-7021
Mailing address
5475 SOUTEL DRIVE, JACKSONVILLE, FL 32219
(904) 764-4576
(904) 766-7021
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN14137
FL
Other
Enumeration date
07/27/2006
Last updated
07/08/2007
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