Poulsen Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

POULSEN DENTAL CORPORATION

Practice address

29121 Newport Road, Ste 1
Menifee, CA 92584

Phone

(951) 228-9296

Fax

(951) 905-1264

NPI assigned

Jul 25, 2017

Organization subpart

No

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

Authorized official

Name

Poulsen D Kyle, DDS

Title

Owner

Phone

(951) 228-9296

Specialties & licenses 1

Addresses

Other names 1

• Menifee Lakes Dental Group Doing business as

Locations

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

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1558884239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8500",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29121 NEWPORT ROAD, STE 1",
            "city": "MENIFEE",
            "state": "CA",
            "postal_code": "92584",
            "telephone_number": "951-228-9296",
            "fax_number": "951-905-1264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POULSEN DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-25",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "KYLE",
        "authorized_official_first_name": "POULSEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-228-9296",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Menifee Lakes Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Menifee Lakes Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Poiema Health Nursing Group PC
• Alyce Popiel
• Elisha Porter
• Amber Portman, LVN
• Portsmouth Senior Home LLC
• Kyle Douglass Poulsen, D.D.S.
• Pourshirazi Dental Corporation
• Homayoun Pourshirazi, D.M.D.
• Andrea Powell
• Jeremy Taylor Powers, DMD

• Dentist in Menifee, CA
• Providers in Menifee, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; 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.