Provider Demographics
NPI:1063995330
Name:JOSHUA T POGUE DMD PC
Entity type:Organization
Organization Name:JOSHUA T POGUE DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:POGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:563-332-7734
Mailing Address - Street 1:920 SNOWBIRD CT
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1272
Mailing Address - Country:US
Mailing Address - Phone:414-213-3928
Mailing Address - Fax:
Practice Address - Street 1:3878 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-5326
Practice Address - Country:US
Practice Address - Phone:563-332-7734
Practice Address - Fax:563-332-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-12
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental