Provider Demographics
NPI:1154789121
Name:MICHAEL L POHLKAMP DDS PA
Entity type:Organization
Organization Name:MICHAEL L POHLKAMP DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:POHLKAMP
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:501-472-1151
Mailing Address - Street 1:16115 SAINT VINCENT WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-3001
Mailing Address - Country:US
Mailing Address - Phone:501-817-3157
Mailing Address - Fax:
Practice Address - Street 1:16115 SAINT VINCENT WAY STE 110
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-3001
Practice Address - Country:US
Practice Address - Phone:501-817-3157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty