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General NPI Number Information
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NPI Number | 1841913985
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Entity Type | Individual
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Provider Name | GRACE I POLO DDS
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Gender | Female
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 5969 E BROAD ST STE 303
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City | COLUMBUS
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State | OH
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Zip | 43213-1539
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Country | US
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Telephone | 514-626-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 6981 HUMMOCK POND
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-7121
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Country | US
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Telephone | 305-370-5390
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 004550
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License Number State | OH
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