Provider Demographics
NPI:1649448382
Name:POLO DENTAL, P.C.
Entity type:Organization
Organization Name:POLO DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:SEBASTIAN
Authorized Official - Last Name:POLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-568-1698
Mailing Address - Street 1:15 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-3673
Mailing Address - Country:US
Mailing Address - Phone:413-568-1698
Mailing Address - Fax:413-568-6198
Practice Address - Street 1:15 NOBLE AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3673
Practice Address - Country:US
Practice Address - Phone:413-568-1698
Practice Address - Fax:413-568-6198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty