MEDICARE: BENNIE CLARK JR. DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN14137	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437173697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENNIE CLARK JR. DMD

Provider Business Mailing Address
First Line	:	5475 SOUTEL DRIVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219
Country	:	US
Telephone Number	:	904-764-4576
Fax Number	:	904-766-7021

Provider Business Practice Location Address
First Line	:	5475 SOUTEL DRIVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219
Country	:	US
Telephone Number	:	904-764-4576
Fax Number	:	904-766-7021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

1346109360 — JOHNATHON TREVINO WEST
Practice Location Address:

8229 HORSEBIT CIR
JACKSONVILLE, FL
32219-3545

Practice Phone: 904-614-8850
Practice Fax:

1912863879 — INFINITE CARE SERVICES LLC
Practice Location Address:

8876 MERSEYSIDE AVE
JACKSONVILLE, FL
32219-4355

Practice Phone: 904-254-0995
Practice Fax:

1558230664 — KAECYN BEHAVIORAL HEALTH SERVICES LLC
Practice Location Address:

10131 FOX LAKE CT
JACKSONVILLE, FL
32219-1693

Practice Phone: 904-525-0418
Practice Fax:

1104822923 — KEEPSAFE CENTER, INC.
Practice Location Address:

5626 SOUTEL DR
JACKSONVILLE, FL
32219-3772

Practice Phone: 904-768-6456
Practice Fax: 904-765-0264

1801842679 — SUSAN E. KURNER LCSW
Practice Location Address:

10149 FOX LAKE CT
JACKSONVILLE, FL
32219-1693

Practice Phone: 352-494-6857
Practice Fax: 888-346-3643

1710992946 — WALGREEN CO
Practice Location Address:

5340 SOUTEL DR
JACKSONVILLE, FL
32219-3478

Practice Phone: 904-764-1773
Practice Fax:

Directions to “ BENNIE CLARK JR. DMD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.