Provider Demographics
NPI:1639484611
Name:POLING, REBECCA LEE (DDS)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LEE
Last Name:POLING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1120 HUFFMAN RD
Mailing Address - Street 2:STE 23, PMB 655
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3516
Mailing Address - Country:US
Mailing Address - Phone:907-903-2830
Mailing Address - Fax:646-217-3024
Practice Address - Street 1:2386 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6401
Practice Address - Country:US
Practice Address - Phone:917-972-0304
Practice Address - Fax:646-217-3024
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0548121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics