Healthcare Provider Details

I. General information

NPI: 1639150659
Provider Name (Legal Business Name): EMIL D POPORAD D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 FULTON DR NW SUITE 102
CANTON OH
44718-2852
US

IV. Provider business mailing address

4124 FULTON DR NW SUITE 102
CANTON OH
44718-2852
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-4700
  • Fax: 330-493-8529
Mailing address:
  • Phone: 330-493-4700
  • Fax: 330-493-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number30-01-4885
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: