Basic Information
| Provider Information | |||||||||
| NPI: | 1730417106 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PAHLS DENTISTRY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 346 N. CENTRAL BLVD | ||||||||
| Address2: | |||||||||
| City: | COQUILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413962242 | ||||||||
| FaxNumber: | 5413963860 | ||||||||
| Practice Location | |||||||||
| Address1: | 346 N. CENTRAL BLVD | ||||||||
| Address2: | |||||||||
| City: | COQUILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413962242 | ||||||||
| FaxNumber: | 5413963860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2009 | ||||||||
| LastUpdateDate: | 11/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | PAHLS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTIAN | ||||||||
| AuthorizedOfficialMiddleName: | BRENT | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 5413962242 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.D.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | D8651 | OR | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Pediatric Dentistry | 122300000X | D8932 | OR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.