NPIMap

Organization Active NPI

Robert C Poulsom DDS Ms LTD

  • Dentist
  • Downers Grove, IL
National Provider Identifier
1669580718
Registry record updated Feb 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019014659 Issued in IL
Legal business name
ROBERT C POULSOM DDS MS LTD
Practice address
6800 S Main St
Suite 206
Downers Grove, IL 60516
Phone
(630) 852-1020
Fax
(630) 968-9229
NPI assigned
Aug 28, 2006
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
Robert Colin Poulsom, DDSNPI 1689744054
Title
President
Phone
(630) 852-1020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 019014659 IL Primary

Addresses

Primary practice location

6800 S Main St
Suite 206
Downers Grove, IL 60516

Mailing address

6800 S Main St
Suite 206
Downers Grove, IL 60516
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.

Locations

6800 Main St
Ste 206
Downers Grove, IL 60516
Phone (630) 810-1277

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266278400000",
    "number": "1669580718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 S MAIN ST",
            "address_2": "SUITE 206",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "60516",
            "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": "6800 S MAIN ST",
            "address_2": "SUITE 206",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "60516",
            "telephone_number": "630-852-1020",
            "fax_number": "630-968-9229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT C POULSOM DDS MS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2010-02-16",
        "status": "A",
        "authorized_official_last_name": "POULSOM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "COLIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-852-1020",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019014659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downers Grove, 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.