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General NPI Number Information
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NPI Number | 1023065315
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Entity Type | Individual
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Provider Name | MARIO EDUARDO POLANCO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 7814 N DALE MABRY HWY
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City | TAMPA
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State | FL
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Zip | 33614-3220
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Country | US
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Telephone | 813-405-3939
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Fax | 813-405-3929
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Provider Business Mailing Address
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Address Line | 8704 SLEEPY OAK PL
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City | TAMPA
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State | FL
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Zip | 33614-1770
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Country | US
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Telephone | 813-405-3939
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Fax | 813-405-3929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN16816
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License Number State | FL
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