Provider Demographics
NPI:1497978324
Name:POER, B L
Entity Type:Individual
Prefix:DR
First Name:B
Middle Name:L
Last Name:POER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16411 SOUTHPARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8468
Mailing Address - Country:US
Mailing Address - Phone:317-896-1986
Mailing Address - Fax:317-896-1886
Practice Address - Street 1:16411 SOUTHPARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8468
Practice Address - Country:US
Practice Address - Phone:317-896-1986
Practice Address - Fax:317-896-1886
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1200-95831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice