Provider Demographics
NPI:1639150659
Name:POPORAD, EMIL D (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:D
Last Name:POPORAD
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 FULTON DR NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2852
Mailing Address - Country:US
Mailing Address - Phone:330-493-4700
Mailing Address - Fax:330-493-8529
Practice Address - Street 1:4124 FULTON DR NW
Practice Address - Street 2:SUITE 102
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2852
Practice Address - Country:US
Practice Address - Phone:330-493-4700
Practice Address - Fax:330-493-8529
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-48851223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0362183Medicaid
OH0505431Medicare ID - Type Unspecified
OH0362183Medicaid