Provider Demographics
NPI:1902002991
Name:POUCHOT, DANIEL E (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:POUCHOT
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 1:165 LEGRANDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE COURTHOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23923
Mailing Address - Country:US
Mailing Address - Phone:434-542-5560
Mailing Address - Fax:434-542-5745
Practice Address - Street 1:165 LEGRANDE AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE COURTHOUSE
Practice Address - State:VA
Practice Address - Zip Code:23923
Practice Address - Country:US
Practice Address - Phone:434-542-5560
Practice Address - Fax:434-542-5745
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist