Organization
CLARK FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL A CLARK DDS (VP)
(985) 624-5449
Entity
Organization
Contact information
Practice address
639 LOTUS DR N, MANDEVILLE, LA 70471
(985) 624-5449
(985) 674-0393
Mailing address
639 LOTUS DR N, MANDEVILLE, LA 70471
(985) 624-5449
(985) 674-0393
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
LA4476
LA
124Q00000X
Dental Hygienist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1844764
—
LA
01
—
A2217
BCBS OF LA
—
Enumeration date
09/26/2006
Last updated
09/11/2025
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