Provider Demographics
NPI:1518957125
Name:CHACE, POLLY
Entity Type:Individual
Prefix:DR
First Name:POLLY
Middle Name:
Last Name:CHACE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 HARMONY AVE
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1455
Mailing Address - Country:US
Mailing Address - Phone:410-544-1153
Mailing Address - Fax:
Practice Address - Street 1:7954 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 1-C
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8188
Practice Address - Country:US
Practice Address - Phone:410-766-2221
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12388122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist