Healthcare Provider Details

I. General information

NPI: 1902002991
Provider Name (Legal Business Name): DANIEL E POUCHOT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 LEGRANDE AVENUE
CHARLOTTE COURTHOUSE VA
23923
US

IV. Provider business mailing address

165 LEGRANDE AVENUE
CHARLOTTE COURTHOUSE VA
23923
US

V. Phone/Fax

Practice location:
  • Phone: 434-542-5560
  • Fax: 434-542-5745
Mailing address:
  • Phone: 434-542-5560
  • Fax: 434-542-5745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401411819
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: