Provider Demographics
NPI:1114037868
Name:POLSTER, CARRIE LYNNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LYNNE
Last Name:POLSTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1635
Mailing Address - Country:US
Mailing Address - Phone:201-444-5675
Mailing Address - Fax:201-447-6967
Practice Address - Street 1:30 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1635
Practice Address - Country:US
Practice Address - Phone:201-444-5675
Practice Address - Fax:201-447-6967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI16159122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist