Healthcare Provider Details

I. General information

NPI: 1619961844
Provider Name (Legal Business Name): POULOS & SOMERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 BROADWAY STE 1135
DENVER CO
80203-3421
US

IV. Provider business mailing address

700 BROADWAY STE 1135
DENVER CO
80203-3421
US

V. Phone/Fax

Practice location:
  • Phone: 303-832-4867
  • Fax: 303-861-7267
Mailing address:
  • Phone: 303-832-4867
  • Fax: 303-861-7267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ANN SOMERS
Title or Position: OWNER
Credential: DDS, MS
Phone: 303-832-4867