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General NPI Number Information
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NPI Number | 1801403886
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Entity Type | Individual
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Provider Name | EDWIN JAKOB POULDAR DDS
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Gender | Male
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 11/04/2023
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Provider Practice Location Address
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Address Line | 14912 BURBANK BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91411-3609
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Country | US
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Telephone | 818-909-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 14912 BURBANK BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91411-3609
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Country | US
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Telephone | 818-909-0222
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 105565
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License Number State | CA
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