Provider Demographics
NPI:1952497349
Name:K. ALEX POOLE II
Entity Type:Organization
Organization Name:K. ALEX POOLE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:K.
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-662-0807
Mailing Address - Street 1:2835 HORSE PEN CREEK RD
Mailing Address - Street 2:106
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9700
Mailing Address - Country:US
Mailing Address - Phone:336-662-0807
Mailing Address - Fax:336-662-0828
Practice Address - Street 1:2835 HORSE PEN CREEK RD
Practice Address - Street 2:106
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9700
Practice Address - Country:US
Practice Address - Phone:336-662-0807
Practice Address - Fax:336-662-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL810-41OtherBCBS OF AL
TXV0068OtherBCBS OF TX
NC96986OtherBCBS OF NC
NC40706OtherBCBS OF TN
NC8996986Medicaid
PA864646OtherBCBS OF PA