Healthcare Provider Details

I. General information

NPI: 1386587020
Provider Name (Legal Business Name): POLISHED DENTAL PROFESSIONALS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 TUSCAN WAY STE 306
ST AUGUSTINE FL
32092-1849
US

IV. Provider business mailing address

46 TUSCAN WAY STE 306
ST AUGUSTINE FL
32092-1849
US

V. Phone/Fax

Practice location:
  • Phone: 904-395-7822
  • Fax: 904-395-7821
Mailing address:
  • Phone: 904-395-7822
  • Fax: 904-395-7821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN G PAGE
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 904-395-7822