Provider Demographics
NPI:1508197518
Name:POLC, DEBORAH KAY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KAY
Last Name:POLC
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 S KERRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5485
Mailing Address - Country:US
Mailing Address - Phone:816-804-5182
Mailing Address - Fax:
Practice Address - Street 1:4203 S KERRINGTON DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5485
Practice Address - Country:US
Practice Address - Phone:816-804-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001028124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist