Provider Demographics
NPI:1205826591
Name:POLT, ALBINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBINA
Middle Name:
Last Name:POLT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ALBINA
Other - Middle Name:
Other - Last Name:POLTIYELOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6610 YELLOWSTONE BLVD
Mailing Address - Street 2:APT #4A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2042
Mailing Address - Country:US
Mailing Address - Phone:718-897-2955
Mailing Address - Fax:
Practice Address - Street 1:3753 91ST ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7901
Practice Address - Country:US
Practice Address - Phone:718-205-4377
Practice Address - Fax:718-205-8605
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0490841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY049084OtherDENTAL LICENSE
NY02117715Medicaid
NY02117715Medicaid