Provider Demographics
NPI:1740805373
Name:POLIRAN, NELSON S JR (DDS MS)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:S
Last Name:POLIRAN
Suffix:JR
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N ROSE DR STE B
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7524
Mailing Address - Country:US
Mailing Address - Phone:714-905-5839
Mailing Address - Fax:
Practice Address - Street 1:620 N ROSE DR STE B
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-7524
Practice Address - Country:US
Practice Address - Phone:714-905-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1089101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice