Provider Demographics
NPI:1225059892
Name:POMINVILLE, ANSELUM LOUIS (DDS)
Entity Type:Individual
Prefix:
First Name:ANSELUM
Middle Name:LOUIS
Last Name:POMINVILLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7626 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1318
Mailing Address - Country:US
Mailing Address - Phone:315-376-3121
Mailing Address - Fax:315-376-8635
Practice Address - Street 1:7626 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1318
Practice Address - Country:US
Practice Address - Phone:315-376-3121
Practice Address - Fax:315-376-8635
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0413911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice