Paul A Clark, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

LA4476 Issued in LA

Practice address

639 Lotus Dr N
Mandeville, LA 70471-2926

Phone

(985) 624-5449

Fax

(985) 674-0393

NPI assigned

Sep 5, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220572800000",
    "number": "1184872947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 LOTUS DR N",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704712926",
            "telephone_number": "985-624-5449",
            "fax_number": "985-674-0393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 LOTUS DR N",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704712926",
            "telephone_number": "985-624-5449",
            "fax_number": "985-674-0393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PAUL",
        "middle_name": "A",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-05",
        "last_updated": "2008-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "LA4476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "#150499",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBC OF LA",
            "identifier": "A2217",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1844764",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peggy Arlene Chunn, LPC
• Carra Maziel Cintron
• Jeffrey Reid Claiborne, M.D.
• Clark Family Dentistry
• Clark Family Dentistry
• Clay Hubble FNP LLC
• Colleen Clendaniel, LCSW
• Clinicore
• Spring Cloud Neill, MD
• Lauren Clutts-Beck, PHARMD

• General Practice Dentistry in Mandeville, LA
• Providers in Mandeville, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.