Provider Demographics
NPI:1104375526
Name:BENJAMIN L POLAN DMD
Entity Type:Organization
Organization Name:BENJAMIN L POLAN DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJMAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-922-1824
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:S104M
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-922-1824
Mailing Address - Fax:978-524-0992
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:S104M
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-922-1824
Practice Address - Fax:978-524-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14772261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental