Provider Demographics
NPI:1043399637
Name:POLOVY, ROBERT STANLEY (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STANLEY
Last Name:POLOVY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 SOUTHWEST PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4100
Mailing Address - Country:US
Mailing Address - Phone:940-696-2064
Mailing Address - Fax:
Practice Address - Street 1:2925 SOUTHWEST PKWY STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4100
Practice Address - Country:US
Practice Address - Phone:940-696-2064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0023039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist