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General NPI Number Information
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NPI Number | 1891426201
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Entity Type | Organization
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Legal Business Name | POLK ORTHODONTICS, LLC
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 06/17/2022
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Provider Practice Location Address
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Address Line | 6425 STAGE RD STE 7
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City | BARTLETT
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State | TN
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Zip | 38134-3731
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Country | US
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Telephone | 901-382-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 6425 STAGE RD STE 7
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City | BARTLETT
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State | TN
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Zip | 38134-3731
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAITLIN POLK
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Credential | DDS, MDS
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Telephone | 580-504-7633
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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 |
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License Number State |
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