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General NPI Number Information
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NPI Number | 1134078454
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Entity Type | Organization
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Legal Business Name | AMANDA ROMSA POLACK, DMD, MS, PC
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Dates
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Enumeration Date | 01/28/2026
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 4900 MASSACHUSETTS AVE NW STE 260
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City | WASHINGTON
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State | DC
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Zip | 20016-4358
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Country | US
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Telephone | 771-210-3484
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Fax | 771-210-3484
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Provider Business Mailing Address
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Address Line | 4900 MASSACHUSETTS AVE NW STE 260
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City | WASHINGTON
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State | DC
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Zip | 20016-4358
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Country | US
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Telephone | 771-210-3484
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Fax | 771-210-3484
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Authorized Official
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Title or Position | DIRECTOR OF PAYOR RELATIONS
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Name | CASSANDRA WIETH
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Credential |
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Telephone | 623-267-8121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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