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General NPI Number Information
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NPI Number | 1639484611
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Entity Type | Individual
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Provider Name | REBECCA LEE POLING DDS
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Gender | Female
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 2386 JEROME AVE
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City | BRONX
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State | NY
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Zip | 10468-6401
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Country | US
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Telephone | 917-972-0304
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Fax | 646-217-3024
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Provider Business Mailing Address
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Address Line | 1120 HUFFMAN RD STE 23, PMB 655
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City | ANCHORAGE
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State | AK
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Zip | 99515-3516
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Country | US
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Telephone | 907-903-2830
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Fax | 646-217-3024
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 054812
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License Number State | NY
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