MEDICARE: DR. DANIEL JOHNSON POELMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8739622-9922	UT

General Provider Information

NPI Number	:	1891048823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JOHNSON POELMAN DDS

Provider Business Mailing Address
First Line	:	714 E FORT UNION BLVD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-2347
Country	:	US
Telephone Number	:	801-784-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	714 E FORT UNION BLVD
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-2347
Country	:	US
Telephone Number	:	801-784-1999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	12/18/2013

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