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General NPI Number Information
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NPI Number | 1386587020
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Entity Type | Organization
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Legal Business Name | POLISHED DENTAL PROFESSIONALS, PLLC
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Dates
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Enumeration Date | 04/09/2026
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 46 TUSCAN WAY STE 306
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-1849
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Country | US
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Telephone | 904-395-7822
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Fax | 904-395-7821
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Provider Business Mailing Address
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Address Line | 46 TUSCAN WAY STE 306
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City | ST AUGUSTINE
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State | FL
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Zip | 32092-1849
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Country | US
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Telephone | 904-395-7822
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Fax | 904-395-7821
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | JUSTIN G PAGE
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Credential | DDS
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Telephone | 904-395-7822
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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 |
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License Number State |
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