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General NPI Number Information
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NPI Number | 1730494147
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Entity Type | Individual
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Provider Name | AMANDA ROMSA POLACK DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 700 PENNSYLVANIA AVE SE STE 370
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City | WASHINGTON
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State | DC
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Zip | 20003-2552
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Country | US
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Telephone | 202-899-5529
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Fax |
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Provider Business Mailing Address
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Address Line | 700 PENNSYLVANIA AVE SE STE 370
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City | WASHINGTON
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State | DC
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Zip | 20003-2552
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Country | US
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Telephone | 262-497-4728
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 019.028461
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DEN1001493
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License Number State | DC
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