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General NPI Number Information
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NPI Number | 1457699589
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Entity Type | Organization
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Legal Business Name | CARLY S. POLIN
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | 2600 N MILITARY TRL SUITE 320
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City | BOCA RATON
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State | FL
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Zip | 33431-6312
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Country | US
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Telephone | 561-997-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 N MILITARY TRL SUITE 320
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City | BOCA RATON
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State | FL
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Zip | 33431-6312
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Country | US
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Telephone | 561-997-2323
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CARLY SARA POLIN
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Credential | DMD
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Telephone | 561-997-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19432
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License Number State | FL
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