Provider Demographics
NPI:1255484044
Name:WILLIAM C POE V DDS INC
Entity Type:Organization
Organization Name:WILLIAM C POE V DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:POE
Authorized Official - Suffix:V
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-594-5067
Mailing Address - Street 1:4012 KATELLA AVE
Mailing Address - Street 2:#203
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720
Mailing Address - Country:US
Mailing Address - Phone:562-594-5067
Mailing Address - Fax:562-596-4134
Practice Address - Street 1:4012 KATELLA AVE
Practice Address - Street 2:#203
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:562-594-5067
Practice Address - Fax:562-596-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty