Provider Demographics
NPI:1205098662
Name:POHLHAUS, JENNY DE LA CRUZ (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:DE LA CRUZ
Last Name:POHLHAUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:ALTAGRACIA
Other - Last Name:DE LA CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5307 PURLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3404
Mailing Address - Country:US
Mailing Address - Phone:410-732-8027
Mailing Address - Fax:
Practice Address - Street 1:5307 PURLINGTON WAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3404
Practice Address - Country:US
Practice Address - Phone:410-732-8027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice