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General NPI Number Information
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NPI Number | 1649448382
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Entity Type | Organization
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Legal Business Name | POLO DENTAL, P.C.
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 15 NOBLE AVE
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City | WESTFIELD
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State | MA
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Zip | 01085-3673
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Country | US
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Telephone | 413-568-1698
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Fax | 413-568-6198
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Provider Business Mailing Address
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Address Line | 15 NOBLE AVE
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City | WESTFIELD
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State | MA
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Zip | 01085-3673
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Country | US
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Telephone | 413-568-1698
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Fax | 413-568-6198
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL SEBASTIAN POLO JR.
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Credential | D.M.D.
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Telephone | 413-568-1698
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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 | 18587
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License Number State | MA
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