Provider Demographics
NPI:1851046957
Name:POU DENTAL OFFICE INC.
Entity Type:Organization
Organization Name:POU DENTAL OFFICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LAURA
Authorized Official - Last Name:POU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-630-7586
Mailing Address - Street 1:1249 W GARDENA BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4884
Mailing Address - Country:US
Mailing Address - Phone:310-327-9392
Mailing Address - Fax:310-327-0511
Practice Address - Street 1:1249 W GARDENA BLVD STE 107
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4884
Practice Address - Country:US
Practice Address - Phone:310-327-9392
Practice Address - Fax:310-327-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty