NPIMap

Organization Active NPI

Robert C. Poulsom, D.D.S., M.S. LTD

  • Periodontics
  • Park Ridge, IL
National Provider Identifier
1275855306
Registry record updated Feb 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
21.000877 Issued in IL
Legal business name
ROBERT C. POULSOM, D.D.S., M.S. LTD
Practice address
350 South NW Highway
Ste 120
Park Ridge, IL 60068
Phone
(630) 852-1020
Fax
(630) 968-9229
NPI assigned
Feb 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert C Poulsom, D.D.S., M.S. JD
Title
Owner/President
Phone
(630) 852-1020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X 21.000877 IL Primary

Addresses

Primary practice location

350 South NW Highway
Ste 120
Park Ridge, IL 60068

Mailing address

350 South NW Highway
Ste 120
Park Ridge, IL 60068
Phone (630) 852-1020

National Provider Directory

National Provider Directory
Tax ID family
Robert C Poulsom DDS Ms LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266278400000",
    "number": "1275855306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 SOUTH NW HIGHWAY",
            "address_2": "STE 120",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "60068",
            "telephone_number": "630-852-1020",
            "fax_number": "630-968-9229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 SOUTH NW HIGHWAY",
            "address_2": "STE 120",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "60068",
            "telephone_number": "630-852-1020",
            "fax_number": "630-968-9229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT C. POULSOM, D.D.S., M.S. LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-16",
        "last_updated": "2010-02-16",
        "status": "A",
        "authorized_official_last_name": "POULSOM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "630-852-1020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S. JD"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": "21.000877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.