Provider Demographics
NPI:1285313437
Name:DR EDWIN POULDAR DDS INC
Entity type:Organization
Organization Name:DR EDWIN POULDAR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:JAKOB
Authorized Official - Last Name:POULDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-780-1187
Mailing Address - Street 1:14912 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-3609
Mailing Address - Country:US
Mailing Address - Phone:818-909-0222
Mailing Address - Fax:
Practice Address - Street 1:14912 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91411-3609
Practice Address - Country:US
Practice Address - Phone:818-909-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty