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General NPI Number Information
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NPI Number | 1528365905
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Entity Type | Organization
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Legal Business Name | ROBERT S. POLOVY, DDS, P.A.
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Dates
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Enumeration Date | 02/19/2011
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Last Update Date | 02/19/2011
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Provider Practice Location Address
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Address Line | 2925 SOUTHWEST PKWY SUITE 500
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City | WICHITA FALLS
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State | TX
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Zip | 76308-4100
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Country | US
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Telephone | 940-696-2064
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 SOUTHWEST PKWY SUITE 500
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City | WICHITA FALLS
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State | TX
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Zip | 76308-4100
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Country | US
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Telephone | 940-696-2064
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT POLOVY
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Credential | DDS
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Telephone | 940-696-2064
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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 |
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License Number State |
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