Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 30.025660 | OH |
N | 1223D0004X | Dentist Anesthesiologist | 010779 | CT |
N | 1223G0001X | General Practice | 010779 | CT |
N | 213EG0000X | General Practice | 010779 | CT |
Y | 1223P0300X | Periodontist | 010779 | CT |
NPI | 1699093351 |
---|---|
Provider Name | Dr. John E.a. Powe |
First Address | Pittsburgh, PA 15221-3415 |
Second Address | West Haven, CT 06516-4405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2010 |
Last Update Date | 07/11/2021 |