Provider Demographics
NPI:1558528935
Name:POLKING & POLKING, P.C.
Entity Type:Organization
Organization Name:POLKING & POLKING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:POLKING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-424-9398
Mailing Address - Street 1:851 S TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1503
Mailing Address - Country:US
Mailing Address - Phone:641-424-9398
Mailing Address - Fax:
Practice Address - Street 1:851 S TAFT AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1503
Practice Address - Country:US
Practice Address - Phone:641-424-9398
Practice Address - Fax:641-424-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA 64221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty