Provider Demographics
NPI:1033570189
Name:POLACK, YONATAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:YONATAN
Middle Name:
Last Name:POLACK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SATELLITE BLVD NW
Mailing Address - Street 2:SUITE 1304
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:770-497-9111
Mailing Address - Fax:770-623-5594
Practice Address - Street 1:1325 SATELLITE BLVD NW
Practice Address - Street 2:SUITE 1304
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:770-497-9111
Practice Address - Fax:770-623-5594
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist