Organization
ROBERT C. POULSOM, D.D.S., M.S. LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT C POULSOM D.D.S., M.S. JD (OWNER/PRESIDENT)
(630) 852-1020
Entity
Organization
Contact information
Practice address
350 SOUTH NW HIGHWAY, STE 120, PARK RIDGE, IL 60068
(630) 852-1020
(630) 968-9229
Mailing address
350 SOUTH NW HIGHWAY, STE 120, PARK RIDGE, IL 60068
(630) 852-1020
(630) 968-9229
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
21.000877
IL
Other
Enumeration date
02/16/2010
Last updated
02/16/2010
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