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General NPI Number Information
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NPI Number | 1649898388
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Entity Type | Organization
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Legal Business Name | POLYVIOU DENTAL CORPORTATION, INC.
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 120 NEWPORT BEACH DRIVE, SUITE 27
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 888-607-5889
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Fax |
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Provider Business Mailing Address
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Address Line | 120 NEWPORT BEACH DRIVE, SUITE 27
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City | NEWPORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 888-607-5889
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. FRED Z BABAEE
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Credential |
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Telephone | 803-608-2743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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