Robert Colin Poulsom, D.D.S., M.S., J.D.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

Practice address

6800 Main St
Ste 206
Downers Grove, IL 60516-3493

Phone

(630) 852-1020

Fax

(630) 968-9229

NPI assigned

Nov 9, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Juris Doctor, Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Robert C Poulsom DDS Ms LTD

  • Dentist
  • Downers Grove, IL
  • NPI 1669580718
  NPD (past) Authorized official
• Robert C. Poulsom, D.D.S., M.S. LTD

  • Periodontics
  • Park Ridge, IL
  • NPI 1275855306
  Authorized official Same address or phone

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689744054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 MAIN ST",
            "address_2": "STE 206",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605163493",
            "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 MAIN ST",
            "address_2": "STE 206",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605163493",
            "telephone_number": "630-852-1020",
            "fax_number": "630-968-9229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULSOM",
        "first_name": "ROBERT",
        "middle_name": "COLIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S., J.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Avaliese Porlier
• Kathleen Anne Post
• Elizabeth Anne Potocnik, M.D.
• Matthew John Potts, SLP
• Glenn R Pouleson, DMD
• Julie Lynn Powers, DPT
• Rachel Helen Powers, MA, LCPC, NCC
• Carlo Prades, MD
• Prairie View Counseling, PLLC
• Tammy Michelle Prater, RN

• Periodontics in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.