Provider Demographics
NPI:1841370897
Name:POLIDORO, CHRISTY
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:POLIDORO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E VAUGHN AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-6451
Mailing Address - Country:US
Mailing Address - Phone:480-206-7682
Mailing Address - Fax:
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-4259
Practice Address - Country:US
Practice Address - Phone:480-813-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH5301124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist