Individual
PAUL A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
639 LOTUS DR N, MANDEVILLE, LA 70471-2926
(985) 624-5449
(985) 674-0393
Mailing address
639 LOTUS DR N, MANDEVILLE, LA 70471-2926
(985) 624-5449
(985) 674-0393
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
LA4476
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
#150499
UNITED CONCORDIA
LA
05
—
1844764
—
LA
01
—
A2217
BCBC OF LA
LA
Enumeration date
09/05/2008
Last updated
09/05/2008
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