MEDICARE: POU DENTAL OFFICE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1851046957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POU DENTAL OFFICE INC.

Provider Business Mailing Address
First Line	:	1249 W GARDENA BLVD STE 107
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-4884
Country	:	US
Telephone Number	:	310-327-9392
Fax Number	:	310-327-0511

Provider Business Practice Location Address
First Line	:	1249 W GARDENA BLVD STE 107
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-4884
Country	:	US
Telephone Number	:	310-327-9392
Fax Number	:	310-327-0511

Authorized Official
Title or Position	:	DENTIST / OWNER
Name	:	SARAH LAURA POU
Credential	:	DDS
Telephone Number	:	949-630-7586

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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Directions to “POU DENTAL OFFICE INC. ” Practice Location

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