Soutel Dental Center Ii

LBN: Bennie Clark Jr Dmd Pa
Soutel Dental Center Ii is an health care organization with primary practice located at 5475 Soutel Dr , Jacksonville FL 32219-3464. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Dental Hygienist. Dental Providers / Dentist is the primary health care specialty. Bennie Clark Jr Dmd Pa can be contacted via phone (904) 764-4576, or through Clark, Lorraine Polite via phone (904) 722-2200.

Contact Information

Primary practice address
5475 Soutel Dr Jacksonville FL 32219-3464
Phone: (904) 764-4576
Fax: (904) 722-9900
Website:
Map and Directions
Authorized official contact:
Name: Clark, Lorraine Polite Doctor of Dental Medicine (DMD)
Phone: (904) 722-2200

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X
Dental Providers / Dental Hygienist 124Q00000X

Profile Details

NPI number 1295023752
LBN Legal business name Bennie Clark Jr Dmd Pa
DBA Doing business as Soutel Dental Center Ii
Authorized official Clark, Lorraine Polite Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Jul 19th, 2011
Last updated Nov 1st, 2019 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295023752 NPPES
Florida MEDICAID 071395300

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