Provider Demographics
NPI:1447516836
Name:C. BRAD POHL, DMD, INC.
Entity type:Organization
Organization Name:C. BRAD POHL, DMD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS / FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KETURAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-384-3278
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45839-0389
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 N. JEFFERSON
Practice Address - Street 2:
Practice Address - City:PANDORA
Practice Address - State:OH
Practice Address - Zip Code:45877
Practice Address - Country:US
Practice Address - Phone:419-384-3278
Practice Address - Fax:419-384-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30023627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty