Healthcare Provider Details

I. General information

NPI: 1447516836
Provider Name (Legal Business Name): C. BRAD POHL, DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N. JEFFERSON
PANDORA OH
45877
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KETURAH HARDING
Title or Position: BUSINESS / FINANCIAL OFFICER
Credential:
Phone: 419-384-3278