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General NPI Number Information
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NPI Number | 1669892840
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER T. POULSEN, DDS, PLLC
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 602 N CALGARY CT SUITE #102
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City | POST FALLS
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State | ID
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Zip | 83854-4000
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Country | US
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Telephone | 208-777-1796
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Fax |
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Provider Business Mailing Address
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Address Line | 602 N CALGARY CT SUITE #102
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City | POST FALLS
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State | ID
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Zip | 83854-4000
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Country | US
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Telephone | 208-777-1796
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST/OWNER
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Name | DR. CHRISTOPHER T POULSEN
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Credential | D.D.S., M.S.
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Telephone | 319-541-6396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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