NPIMap

Organization Active NPI

Clark Family Dentistry

  • General Practice Dentistry
  • Mandeville, LA
National Provider Identifier
1891896148
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
LA4476 Issued in LA
Legal business name
CLARK FAMILY DENTISTRY
Practice address
639 Lotus Dr N
Mandeville, LA 70471
Phone
(985) 624-5449
Fax
(985) 674-0393
NPI assigned
Sep 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Dr. Paul A Clark, DDS
Title
VP
Phone
(985) 624-5449

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X LA4476 LA Primary
Dental HygienistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 124Q00000X

Addresses

Primary practice location

639 Lotus Dr N
Mandeville, LA 70471

Mailing address

639 Lotus Dr N
Mandeville, LA 70471
Phone (985) 624-5449

Other identifiers 2

IdentifierTypeStateIssuer
1844764MedicaidLA
A2217OtherBCBS OF LA

National Provider Directory

National Provider Directory
Tax ID family
Clark Family Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1891896148",
    "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": "70471",
            "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": "70471",
            "telephone_number": "985-624-5449",
            "fax_number": "985-674-0393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "985-624-5449",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "LA4476",
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1844764",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF LA",
            "identifier": "A2217",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandeville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.