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Organization
POULSEN DENTAL CORPORATION
Active
Organization
POULSEN DENTAL CORPORATION
Active
Other names
Menifee Lakes Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
POULSEN D KYLE DDS (OWNER)
(951) 228-9296
Entity
Organization
Contact information
Practice address
29121 NEWPORT ROAD, STE 1, MENIFEE, CA 92584
(951) 228-9296
(951) 905-1264
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
(714) 845-8500
(949) 474-1495
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/25/2017
Last updated
03/08/2022
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