Provider Demographics
NPI:1750470944
Name:PAHLS, HERMAN CHRISTIAN (DDS)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:CHRISTIAN
Last Name:PAHLS
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 1:346 N CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:COQUILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97423-1244
Mailing Address - Country:US
Mailing Address - Phone:541-396-2242
Mailing Address - Fax:541-396-3836
Practice Address - Street 1:346 N CENTRAL ST
Practice Address - Street 2:
Practice Address - City:COQUILLE
Practice Address - State:OR
Practice Address - Zip Code:97423-1244
Practice Address - Country:US
Practice Address - Phone:541-396-2242
Practice Address - Fax:541-396-3836
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR54651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice