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General NPI Number Information
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NPI Number | 1467475129
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Entity Type | Individual
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Provider Name | LORRAINE POLITE CLARK DMD
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 12517 YELLOW BLUFF RD
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City | JACKSONVILLE
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State | FL
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Zip | 32226-3809
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Country | US
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Telephone | 904-204-7496
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Fax |
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Provider Business Mailing Address
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Address Line | 5475 SOUTEL DR
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City | JACKSONVILLE
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State | FL
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Zip | 32219-3464
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Country | US
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Telephone | 904-764-4576
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Fax | 904-766-7021
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN14105
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License Number State | FL
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