Provider Demographics
NPI:1093130270
Name:PRESTON H. POLSON D.D.S, P.C.
Entity Type:Organization
Organization Name:PRESTON H. POLSON D.D.S, P.C.
Other - Org Name:MEADOWS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:POLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-660-5576
Mailing Address - Street 1:3740 DACORO LN STE 115
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2510
Mailing Address - Country:US
Mailing Address - Phone:303-660-5576
Mailing Address - Fax:303-660-5425
Practice Address - Street 1:3740 DACORO LN STE 115
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2510
Practice Address - Country:US
Practice Address - Phone:303-660-5576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty