Individual
DR. EMILY POULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1113 S SIGNAL BUTTE RD, MESA, AZ 85208-3918
(480) 582-1199
Mailing address
9857 E EL MORO AVE, MESA, AZ 85208-5867
(919) 475-2767
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D010240
AZ
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4167-20
MS
Other
Enumeration date
01/29/2019
Last updated
01/21/2021
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