Provider Demographics
NPI:1396894507
Name:MICHAEL A POLECK DDS PA
Entity type:Organization
Organization Name:MICHAEL A POLECK DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-999-0111
Mailing Address - Street 1:5501 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-999-0111
Mailing Address - Fax:302-999-1444
Practice Address - Street 1:5501 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-999-0111
Practice Address - Fax:302-999-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty