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General NPI Number Information
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NPI Number | 1720204845
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Entity Type | Individual
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Provider Name | OWEN WILLIAM POULSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 711 ZION STREET
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City | NEVADA CITY
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State | CA
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Zip | 95959
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Country | US
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Telephone | 530-265-2280
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Fax | 530-265-5305
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Provider Business Mailing Address
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Address Line | 204 TUTTLE CREEK BLVD
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City | MANHATTAN
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State | KS
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Zip | 66502
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Country | US
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Telephone | 785-560-6078
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Fax | 785-371-0133
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 45757
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60866
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License Number State | KS
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