Provider Demographics
NPI:1841913985
Name:POLO, GRACE I (DDS)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:I
Last Name:POLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6981 HUMMOCK POND
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7121
Mailing Address - Country:US
Mailing Address - Phone:305-370-5390
Mailing Address - Fax:
Practice Address - Street 1:5969 E BROAD ST STE 303
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1539
Practice Address - Country:US
Practice Address - Phone:514-626-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0045501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice