Provider Demographics
NPI:1750500799
Name:CLARK, STEVEN ARTHUR (DDS)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ARTHUR
Last Name:CLARK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9141 CYPRESS GREEN DRIVE
Mailing Address - Street 2:#4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-737-1232
Mailing Address - Fax:904-737-0477
Practice Address - Street 1:9141 CYPRESS GREEN DRIVE
Practice Address - Street 2:#4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-737-1232
Practice Address - Fax:904-737-0477
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist