Healthcare Provider Details

I. General information

NPI: 1649695339
Provider Name (Legal Business Name): POLISHED HOLDINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15811 N FRANK LLOYD WRIGHT BLVD SUITE 130
SCOTTSDALE AZ
85260-3000
US

IV. Provider business mailing address

15210 N SCOTTSDALE RD SUITE 240
SCOTTSDALE AZ
85254-8124
US

V. Phone/Fax

Practice location:
  • Phone: 480-767-1077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH007556
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH007508
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7870
License Number StateAZ

VIII. Authorized Official

Name: MR. TAYLOR BLACKWOOD
Title or Position: PRESIDENT
Credential:
Phone: 901-275-0572