DR. JAMES KELLY POULSEN


Address: 1453 W Hays, Boise, ID 83702
Phone: 2083456287

DR. JAMES KELLY POULSEN (NPI# 1265535298) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1265535298
Entity Type Individual
Full Name DR. JAMES KELLY POULSEN
Credential DDS MS
Practice Address 1453 W Hays
Boise
ID 83702
Practice Telephone 2083456287
Practice Fax Number 2083450661
Mailing Telephone 2083456287
Mailing Fax Number 2083450661
Enumeration Date 2006-09-06
Last Update Date 2007-07-08
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1223X0400X Dentist
Specialization: Orthodontics and Dentofacial Orthopedics
D-2070-OR ID Dental Providers

Other Provider Identifier

State Issuer Identifier Type Code
UNITED CONCORDIA 440946 01
BLUE CROSS BLUE SHIELD 60913 01

Office Location

Street Address 1453 W HAYS
City BOISE
State ID
Zip Code 83702

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1427504398 The Young Mens Christian Association of Boise City Idaho Health Educator 419 N 11th St, Boise, ID 83702 2016-08-30
1942756838 Brent Hiroshi Sasaki Pharmacist 500 West Fort Street (119), Boise, ID 83702 2016-08-30
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Taxonomy Information

Taxonomy Code 1223X0400X
Grouping Dental Providers
Classification Dentist
Specialization Orthodontics and Dentofacial Orthopedics

Taxonomy Definition

That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1801061080 Laura Kathleen Lineberry Dentist 13059 W Persimmon Ln, Boise, ID 83713-1986 2008-04-28
1194910778 Scott D Alexander Dentist 3167 South Bown Way, Boise, ID 83706 2007-09-07
1952504318 Jacob Reed Jarivs Dentist 6000 S Quamash Way, Boise, ID 83716-5617 2007-06-05
1588879399 Jon Miler Dentist 5220 N Eagle Rd, Boise, ID 83713-0945 2007-05-14
1194814251 Steven David Gilman Dentist 7301 W Emerald St Ste 101, Boise, ID 83704-8689 2006-10-12
1396843058 Marcus Lowry Dentist 9460 W. Franklin Rd, Boise, ID 83709 2006-09-20
1346344884 John C. Slattery Dentist 600 E Riverpark Ln, Suite 100, Boise, ID 83706-6551 2006-09-12
1043322548 Terrell F Tingey Dentist 2020 N Cole Rd, Boise, ID 83704 2006-08-31
1205943669 John C Matunas Dentist 8000 Ustick Rd, Boise, ID 83704-5751 2006-08-23
1013920313 Samuel G. Smith Dentist 1541 S. Times Square, Boise, ID 83709 2006-08-15
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Competitor

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City BOISE
Zip Code 83702

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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