Paul M. Clark Jr., DDS

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

2432 Issued in LA

Practice address

2120 Bert Kouns Industrial Loop
Suite D
Shreveport, LA 71118-3351

Phone

(318) 687-9800

Fax

(318) 687-4752

NPI assigned

Aug 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• David K Clark DDS - Oral Surgery Associates-Apdc

  • Oral and Maxillofacial Surgery Clinic/Center
  • Shreveport, LA
  • NPI 1497054613
  NPD (past)

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386758936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE D",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183351",
            "telephone_number": "318-687-9800",
            "fax_number": "318-687-4752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE D",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183351",
            "telephone_number": "318-687-9800",
            "fax_number": "318-687-4752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "PAUL",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "LA",
            "license": "2432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Vinceson Clark Jr., MHS
• Eric Vinceson Clark Sr.
• Erica Clark
• Lazaria S Clark
• Marche' Clark
• Phillip Clark
• Porsha Lynniece Clark
• Shamika Clark
• Shanika Clark
• Stephen W. Clark, CRNA

• Oral and Maxillofacial Pathology Dentistry in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Oral and Maxillofacial Pathology Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.