Provider Demographics
NPI:1942211263
Name:CLARK, PAUL A II (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:CLARK
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6750 POPLAR AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7438
Mailing Address - Country:US
Mailing Address - Phone:901-309-3045
Mailing Address - Fax:901-309-3065
Practice Address - Street 1:6750 POPLAR AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-7438
Practice Address - Country:US
Practice Address - Phone:901-309-3045
Practice Address - Fax:901-309-3065
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000074991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice