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General NPI Number Information
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NPI Number | 1669728002
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Entity Type | Individual
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Provider Name | DR. ELIZABETH ASHLEY POLAK
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Gender | Female
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 888 BESTGATE RD STE 300
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City | ANNAPOLIS
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State | MD
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Zip | 21401-2955
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Country | US
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Telephone | 303-880-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 24 HUNTING CT UNIT 22
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City | EDGEWATER
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State | MD
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Zip | 21037-1232
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Country | US
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Telephone | 303-880-1999
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 17400
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License Number State | MD
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