Provider Demographics
NPI:1982850574
Name:POLGREAN, RACHEL JANE (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:JANE
Last Name:POLGREAN
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 GILCREAST RD
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3518
Mailing Address - Country:US
Mailing Address - Phone:603-434-0190
Mailing Address - Fax:603-421-9550
Practice Address - Street 1:77 GILCREAST RD
Practice Address - Street 2:SUITE 3000
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3518
Practice Address - Country:US
Practice Address - Phone:603-434-0190
Practice Address - Fax:603-421-9550
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH031511223X0400X
CADDS412081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics