Provider Demographics
NPI:1801800420
Name:POLING, TIM ELDEN (DDS)
Entity type:Individual
Prefix:DR
First Name:TIM
Middle Name:ELDEN
Last Name:POLING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:200 W WASHINGTON
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:KS
Mailing Address - Zip Code:67756-0867
Mailing Address - Country:US
Mailing Address - Phone:785-332-3103
Mailing Address - Fax:785-332-2289
Practice Address - Street 1:200 W WASHINGTON
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:KS
Practice Address - Zip Code:67756-0867
Practice Address - Country:US
Practice Address - Phone:785-332-3103
Practice Address - Fax:785-332-2289
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice