1205098662 NPI number — DR. JENNY DE LA CRUZ POHLHAUS DDS

Table of content: DR. JENNY DE LA CRUZ POHLHAUS DDS (NPI 1205098662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205098662 NPI number — DR. JENNY DE LA CRUZ POHLHAUS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POHLHAUS
Provider First Name:
JENNY
Provider Middle Name:
DE LA CRUZ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LA CRUZ
Provider Other First Name:
JENNY
Provider Other Middle Name:
ALTAGRACIA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205098662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5307 PURLINGTON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21212-3404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-732-8027
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5307 PURLINGTON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-732-8027
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  14046 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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