Healthcare Provider Details

I. General information

NPI: 1629654942
Provider Name (Legal Business Name): CARA CLARK HILL DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 NW 69TH TER STE E
GAINESVILLE FL
32605-3139
US

IV. Provider business mailing address

1204 NW 69TH TER STE E
GAINESVILLE FL
32605-3139
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-9992
  • Fax: 352-331-9676
Mailing address:
  • Phone: 352-331-9992
  • Fax: 352-331-9676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: CARA HILL
Title or Position: OWNER
Credential: DMD
Phone: 352-331-9992