Healthcare Provider Details

I. General information

NPI: 1295895183
Provider Name (Legal Business Name): DRS. JIAN, SPANN & ASSOCIATES (POLARIS), INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 POLARIS PARKWAY
COLUMBUS OH
43240-2040
US

IV. Provider business mailing address

7160 NORTH DALLAS PARKWAY ST 400
PLANO TX
75024-7145
US

V. Phone/Fax

Practice location:
  • Phone: 614-985-3338
  • Fax: 216-584-1025
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL NITTINGER
Title or Position: MANAGER, CREDENTIALING
Credential:
Phone: 972-755-0816