Emil D Poporad, D.D.S.,M.S.

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

30-01-4885 Issued in OH

Practice address

4124 Fulton Dr NW
Suite 102
Canton, OH 44718-2852

Phone

(330) 493-4700

Fax

(330) 493-8529

NPI assigned

Nov 8, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317945600000",
    "number": "1639150659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4124 FULTON DR NW",
            "address_2": "SUITE 102",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182852",
            "telephone_number": "330-493-4700",
            "fax_number": "330-493-8529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4124 FULTON DR NW",
            "address_2": "SUITE 102",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447182852",
            "telephone_number": "330-493-4700",
            "fax_number": "330-493-8529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPORAD",
        "first_name": "EMIL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S.,M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2011-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "OH",
            "license": "30-01-4885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0362183",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Johanna Rae Poore, MA, BCBA COBA
• Jennifer Popa, PHARMD
• Tracy Ann Popa, CRNP
• Rajean Pope
• Regina Pope
• Ardith Elise Porosky
• Tottie A Porrini
• Porter Chiropractic Clinic
• Andrea Leigh Porter, PTA
• Cassandra E Porter, NP

• Oral and Maxillofacial Pathology Dentistry in Canton, OH
• Providers in Canton, OH by specialty
• Oral and Maxillofacial Pathology Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.