Provider Demographics
NPI:1710276910
Name:POLECK, NATHAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:POLECK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5001
Mailing Address - Country:US
Mailing Address - Phone:302-994-7730
Mailing Address - Fax:302-994-5598
Practice Address - Street 1:5501 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5001
Practice Address - Country:US
Practice Address - Phone:302-994-7730
Practice Address - Fax:302-994-5598
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0385541223G0001X
NJ22DI02472500122300000X
DEG1-0001304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice