Provider Demographics
NPI:1427587005
Name:MAGEE, POLINA JAYEVNA (DMD)
Entity Type:Individual
Prefix:
First Name:POLINA
Middle Name:JAYEVNA
Last Name:MAGEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:POLINA
Other - Middle Name:JAYEVNA
Other - Last Name:MAGEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:7100 W GRANDVIEW RD APT 2067
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-4920
Mailing Address - Country:US
Mailing Address - Phone:803-517-7614
Mailing Address - Fax:
Practice Address - Street 1:980 WILLOW CREEK RD STE 103
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1619
Practice Address - Country:US
Practice Address - Phone:928-460-5618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0097691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice