Healthcare Provider Details

I. General information

NPI: 1265734792
Provider Name (Legal Business Name): CHARLES B POHL D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2010
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E. MAIN STREET
LEIPSIC OH
45856
US

IV. Provider business mailing address

PO BOX 389
FINDLAY OH
45839-0389
US

V. Phone/Fax

Practice location:
  • Phone: 419-384-3278
  • Fax: 419-384-3280
Mailing address:
  • Phone: 785-766-9770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30023627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: