Healthcare Provider Details

I. General information

NPI: 1366350373
Provider Name (Legal Business Name): JONAH ROBERT POOLE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4655 MORSE CENTRE RD
COLUMBUS OH
43229-6601
US

IV. Provider business mailing address

6382 PRESERVE CROSSING BLVD N
COLUMBUS OH
43230-6488
US

V. Phone/Fax

Practice location:
  • Phone: 614-470-9840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.028652
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: