Provider Demographics
NPI:1134656689
Name:POLSTER, EITAN JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:EITAN
Middle Name:JOSEPH
Last Name:POLSTER
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 1:2274 HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1376
Mailing Address - Country:US
Mailing Address - Phone:216-337-7647
Mailing Address - Fax:
Practice Address - Street 1:7123 PEARL RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4944
Practice Address - Country:US
Practice Address - Phone:440-888-6783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30025054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist