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General NPI Number Information
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NPI Number | 1285401570
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Entity Type | Organization
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Legal Business Name | RYAN C POLMAN, DDS, LLC
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 8193 AVERY RD STE 100
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-1673
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Country | US
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Telephone | 440-736-7019
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Fax |
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Provider Business Mailing Address
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Address Line | 35720 W ISLAND DR
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City | EASTLAKE
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State | OH
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Zip | 44095-1736
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. RYAN POLMAN
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Credential | DDS
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Telephone | 440-736-7019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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