Healthcare Provider Details

I. General information

NPI: 1578789632
Provider Name (Legal Business Name): DAVID C POELMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 E RAY RD SUITE 7
CHANDLER AZ
85225-1771
US

IV. Provider business mailing address

185 S 163RD ST
GILBERT AZ
85296-9475
US

V. Phone/Fax

Practice location:
  • Phone: 480-792-6880
  • Fax: 480-792-6870
Mailing address:
  • Phone: 480-203-6415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberAZ05638
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: