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General NPI Number Information
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NPI Number | 1710522958
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Entity Type | Individual
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Provider Name | TERA POOLE DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 8050 HOSBROOK RD STE 310
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City | CINCINNATI
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State | OH
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Zip | 45236-2907
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Country | US
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Telephone | 513-772-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 5361 GRAND VISTA CT
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City | CINCINNATI
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State | OH
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Zip | 45227-1955
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Country | US
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Telephone | 513-560-0212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 104695
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.025691
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30.025691
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License Number State | OH
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