Provider Demographics
NPI:1598890725
Name:POLSON, RUTH PENTON (DMD)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:PENTON
Last Name:POLSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:PENTON
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3145 GREEN VALLEY ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VESTANA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35243
Mailing Address - Country:US
Mailing Address - Phone:205-970-7292
Mailing Address - Fax:205-623-3036
Practice Address - Street 1:3145 GREEN VALLEY ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:VESTANA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-970-7292
Practice Address - Fax:205-623-3036
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice