Jill Elizabeth Poulos, D.D.S.
Individual provider Active NPI General Practice Dentistry · Cambria, CA
NPI 1043429608 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043429608
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 32667 (CA)
- Practice address
- 4235 Bridge St
Cambria, CA 93428-2101 - Phone
- (805) 927-5797
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160224002362 | CA | Order and Referring Only - Dentist |
6608171905 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ratchford Dental Practice of Cambria, Inc | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 32667 | CA | Yes |
Addresses
Primary practice location
4235 Bridge St
Cambria, CA 93428-2101
Mailing address
4235 Bridge St
Cambria, CA 93428-2101
Phone (805) 927-5797
Other providers in Cambria, CA
- Paul F. Nielson, M.D., Inc.
- Dennis Alan Perry
- Kathryn A Perry
- Mary Elizabeth Phillips
- Spencer Gordon Plante
- Ratchford Dental Practice of Cambria, Inc
- Olivia Gail Redwine
- Jana Kokkonen Reed
- Richard David Griffith MD, Inc.
- Melissa Renee Sanden
All providers in Cambria, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.