Provider Demographics
NPI:1891735759
Name:POLAND, CHARLES II (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:POLAND
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5625 CASTLE CREEK PKY N. DR.
Mailing Address - Street 2:SUITE 125
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4304
Mailing Address - Country:US
Mailing Address - Phone:317-849-2606
Mailing Address - Fax:317-585-0006
Practice Address - Street 1:7526 E 82ND ST
Practice Address - Street 2:SUITE 125
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1461
Practice Address - Country:US
Practice Address - Phone:317-849-2606
Practice Address - Fax:317-579-8769
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120065221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100056010Medicaid