Provider Demographics
NPI:1487769121
Name:CORENE J. POELMAN, D.D.S., M.S., APC
Entity type:Organization
Organization Name:CORENE J. POELMAN, D.D.S., M.S., APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CORENE
Authorized Official - Middle Name:JANNA
Authorized Official - Last Name:POELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:858-676-6709
Mailing Address - Street 1:16466 BERNARDO CENTER DR
Mailing Address - Street 2:SUITE 176
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2508
Mailing Address - Country:US
Mailing Address - Phone:858-676-6709
Mailing Address - Fax:858-676-6739
Practice Address - Street 1:16466 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 176
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2508
Practice Address - Country:US
Practice Address - Phone:858-676-6709
Practice Address - Fax:858-676-6739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443551223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty