Provider Demographics
NPI:1730417106
Name:PAHLS DENTISTRY PC
Entity type:Organization
Organization Name:PAHLS DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:PAHLS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-396-2242
Mailing Address - Street 1:346 N. CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:COQUILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97423
Mailing Address - Country:US
Mailing Address - Phone:541-396-2242
Mailing Address - Fax:541-396-3860
Practice Address - Street 1:346 N. CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:COQUILLE
Practice Address - State:OR
Practice Address - Zip Code:97423
Practice Address - Country:US
Practice Address - Phone:541-396-2242
Practice Address - Fax:541-396-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86511223P0221X
ORD8932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty