Provider Demographics
NPI:1568634418
Name:POU, MIGUEL B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:B
Last Name:POU
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 1:98 WEST JERSEY ST.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202
Mailing Address - Country:US
Mailing Address - Phone:908-353-8989
Mailing Address - Fax:908-353-7797
Practice Address - Street 1:98 W JERSEY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-2108
Practice Address - Country:US
Practice Address - Phone:908-353-8989
Practice Address - Fax:908-353-7797
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ181861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice