| Robert C. Poulsom, D.d.s., M.s. Ltd | |
|
350 South Nw Highway Ste 120 Park Ridge IL 60068 | |
| (630) 852-1020 | |
| (630) 968-9229 |
| Full Name | Robert C. Poulsom, D.d.s., M.s. Ltd |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 350 South Nw Highway, Park Ridge, Illinois |
| Authorized Official Name and Position | Robert C Poulsom (OWNER/PRESIDENT) |
| Authorized Official Contact | 6308521020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert C. Poulsom, D.d.s., M.s. Ltd 350 South Nw Highway Ste 120 Park Ridge IL 60068 Ph: (630) 852-1020 | Robert C. Poulsom, D.d.s., M.s. Ltd 350 South Nw Highway Ste 120 Park Ridge IL 60068 Ph: (630) 852-1020 |
| NPI Number | 1275855306 |
|---|---|
| Provider Enumeration Date | 02/16/2010 |
| Last Update Date | 02/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275855306 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | 21.000877 (Illinois) | Primary |
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