Healthcare Provider Details

I. General information

NPI: 1699093351
Provider Name (Legal Business Name): JOHN E.A. POWE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 11/07/2021
Certification Date: 11/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 CENTER ST
WEST HAVEN CT
06516-4405
US

IV. Provider business mailing address

617 S BRADDOCK AVE
PITTSBURGH PA
15221-3415
US

V. Phone/Fax

Practice location:
  • Phone: 202-427-7416
  • Fax:
Mailing address:
  • Phone: 917-564-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025660
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number010779
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number010779
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number010779
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: