Provider Demographics
NPI:1942565817
Name:POLINKOVSKY, LEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:POLINKOVSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:LEONID
Other - Middle Name:
Other - Last Name:POLINKOVSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:511 CROSSING DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2629
Mailing Address - Country:US
Mailing Address - Phone:303-664-1001
Mailing Address - Fax:
Practice Address - Street 1:511 CROSSING DR STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026
Practice Address - Country:US
Practice Address - Phone:303-664-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2025521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice