MEDICARE: DR. JAMES A. POE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30021165	OH

General Provider Information

NPI Number	:	1942216858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES A. POE DDS

Provider Business Mailing Address
First Line	:	4770 W BROAD ST
Second Line	:	LINCOLN VILLAGE PLAZA
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 W BROAD ST
Second Line	:	LINCOLN VILLAGE PLAZA
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1613
Country	:	US
Telephone Number	:	614-851-3295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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