Provider Demographics
NPI:1124631106
Name:POENARU, NATANAEL (DDS)
Entity type:Individual
Prefix:
First Name:NATANAEL
Middle Name:
Last Name:POENARU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 SEQUOIA CIR
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5422
Mailing Address - Country:US
Mailing Address - Phone:509-675-0314
Mailing Address - Fax:
Practice Address - Street 1:825 SEQUOIA CIR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5422
Practice Address - Country:US
Practice Address - Phone:509-675-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATP61101182122300000X
CA107150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist