Provider Demographics
NPI:1558317750
Name:POLSON, J. RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:J. RICHARD
Middle Name:
Last Name:POLSON
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 1:2121 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5993
Mailing Address - Country:US
Mailing Address - Phone:817-283-0025
Mailing Address - Fax:817-571-9571
Practice Address - Street 1:2121 MARTIN DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5993
Practice Address - Country:US
Practice Address - Phone:817-283-0025
Practice Address - Fax:817-571-9571
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist