Provider Demographics
NPI:1619248697
Name:POB ASSOCIATES, PL
Entity Type:Organization
Organization Name:POB ASSOCIATES, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-359-8962
Mailing Address - Street 1:1010 SE KITCHING COVE LN
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5902
Mailing Address - Country:US
Mailing Address - Phone:772-359-8962
Mailing Address - Fax:800-408-7001
Practice Address - Street 1:1657 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5428
Practice Address - Country:US
Practice Address - Phone:772-337-4115
Practice Address - Fax:772-337-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty