Provider Demographics
NPI:1649898388
Name:POLYVIOU DENTAL CORPORTATION, INC.
Entity type:Organization
Organization Name:POLYVIOU DENTAL CORPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BABAEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-608-2743
Mailing Address - Street 1:120 NEWPORT BEACH DRIVE, SUITE 27
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:888-607-5889
Mailing Address - Fax:
Practice Address - Street 1:120 NEWPORT BEACH DRIVE, SUITE 27
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:888-607-5889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental