Individual
DR. KEITH J POULSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
7138 HIGHLAND DR, SUITE 216, SALT LAKE CITY, UT 84121-3757
(801) 944-0668
(801) 944-4482
Mailing address
7138 HIGHLAND DR, SUITE 216, SALT LAKE CITY, UT 84121-3757
(801) 944-0668
(801) 944-4482
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
134901
UT
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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