Provider Demographics
NPI:1033542832
Name:POPAT, POONAM V (DMD)
Entity Type:Individual
Prefix:DR
First Name:POONAM
Middle Name:V
Last Name:POPAT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9625 LAKE NONA VILLAGE PLACE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827
Mailing Address - Country:US
Mailing Address - Phone:407-203-4100
Mailing Address - Fax:407-203-4440
Practice Address - Street 1:9625 LAKE NONA VILLAGE PLACE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827
Practice Address - Country:US
Practice Address - Phone:407-203-4100
Practice Address - Fax:407-203-4440
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist