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General NPI Number Information
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NPI Number | 1518657766
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Entity Type | Individual
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Provider Name | ANDREW HARI POLENAKOVIK DDS
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Gender | Male
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 207 COLUMBUS RD
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City | ATHENS
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State | OH
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Zip | 45701-1335
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Country | US
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Telephone | 740-593-8530
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Fax |
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Provider Business Mailing Address
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Address Line | 226 GREENMOUNT BLVD
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City | OAKWOOD
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State | OH
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Zip | 45419-3242
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Country | US
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Telephone | 937-733-3009
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.027164
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License Number State | OH
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