Dental Board of California
Licensing details for: 82335
Name: KYLE POULSEN, DDS
License Type: Additional Office Permit
Primary Status: Current - Active
Organization Classification: Corporation
Previous Names: Grand Terrace Modern Dentistry, Inc.
Address of Record
22471 Barton Road
GRAND TERRACE CA 92313
Map
License Relationships
AO to DDS or OMS (Owners)
License/Registration Role: Additional Office Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Name: POULSEN, KYLE DOUGLASS
License/Registration Type: Dentist License
License Number: 64955 Primary Status: Current - Active
Address :
32891 Western Hills Dr
Ste 103
WINCHESTER CA 92596
RIVERSIDE COUNTY
