Active NPI
Justin D Poulson, DMD
- Dentist
- Soldotna, AK
National Provider Identifier
1639587348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1572
- Practice address
- 47707 Judy Lynn Lane
Soldotna, AK 99669 - Phone
- (907) 283-9125
- Fax
- (907) 283-9184
- NPI assigned
- Jul 25, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1572 | AK | Primary |
Addresses
Primary practice location
47707 Judy Lynn Lane
Soldotna, AK 99669
Mailing address
47707 Judy Lynn Lane
Soldotna, AK 99669
Phone (907) 283-9125
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1572 | AK | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1770854400000",
"number": "1639587348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "47707 JUDY LYNN LANE",
"city": "SOLDOTNA",
"state": "AK",
"postal_code": "99669",
"telephone_number": "907-283-9125",
"fax_number": "907-283-9184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "47707 JUDY LYNN LANE",
"city": "SOLDOTNA",
"state": "AK",
"postal_code": "99669",
"telephone_number": "907-283-9125",
"fax_number": "907-283-9184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POULSON",
"first_name": "JUSTIN",
"middle_name": "D",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-25",
"last_updated": "2026-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AK",
"license": "1572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Soldotna, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.