Provider Demographics
NPI:1437423928
Name:POLSKY DDS &VIRK DMD MS PS
Entity Type:Organization
Organization Name:POLSKY DDS &VIRK DMD MS PS
Other - Org Name:DENTAL SURGERY CENTER OF AUBURN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-792-3007
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-0696
Mailing Address - Country:US
Mailing Address - Phone:360-736-0928
Mailing Address - Fax:360-736-0921
Practice Address - Street 1:1002 15TH ST SW
Practice Address - Street 2:SUITE 215
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-6502
Practice Address - Country:US
Practice Address - Phone:253-736-6600
Practice Address - Fax:253-736-6601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POLSKYDDS&VIRK DMD MS PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental