Provider Demographics
NPI:1497976872
Name:POLZIN, J SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:SCOTT
Last Name:POLZIN
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 1:1425 E JOHN ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-3468
Mailing Address - Country:US
Mailing Address - Phone:920-733-8129
Mailing Address - Fax:920-733-6183
Practice Address - Street 1:1425 E JOHN ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-3468
Practice Address - Country:US
Practice Address - Phone:920-733-8129
Practice Address - Fax:920-733-6183
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1753 G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist