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General NPI Number Information
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NPI Number | 1164580197
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Entity Type | Individual
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Provider Name | GERALD PARKER POULSEN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3105 W 5400 S
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City | TAYLORSVILLE
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State | UT
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Zip | 84118-2200
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Country | US
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Telephone | 801-969-6236
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Fax | 801-966-4572
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Provider Business Mailing Address
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Address Line | 3105 W 5400 S
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City | TAYLORSVILLE
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State | UT
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Zip | 84118-2200
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Country | US
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Telephone | 801-969-6236
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Fax | 801-966-4572
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 131024-9921
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License Number State | UT
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