Provider Demographics
NPI:1326183120
Name:POLSINELLO, MARK J (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:POLSINELLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:399 ALBANY SHAKER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1961
Mailing Address - Country:US
Mailing Address - Phone:518-438-1131
Mailing Address - Fax:518-438-9490
Practice Address - Street 1:399 ALBANY SHAKER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1961
Practice Address - Country:US
Practice Address - Phone:518-438-1131
Practice Address - Fax:518-438-9490
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0454651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice