Provider Demographics
NPI:1508155383
Name:POLKA, KARLY SUK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARLY
Middle Name:SUK
Last Name:POLKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 CEDAR CIR
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1646
Mailing Address - Country:US
Mailing Address - Phone:585-410-3795
Mailing Address - Fax:
Practice Address - Street 1:709 CEDAR CIR
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1646
Practice Address - Country:US
Practice Address - Phone:585-410-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056297122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist