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General NPI Number Information
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NPI Number | 1902053135
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Entity Type | Individual
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Provider Name | BRIEN R. POLK DDS
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Gender | Male
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 95 US HIGHWAY 51 BYP W
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City | DYERSBURG
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State | TN
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Zip | 38024-1935
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Country | US
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Telephone | 731-286-1271
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Fax |
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Provider Business Mailing Address
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Address Line | 731 N SAMPSON AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-3961
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Country | US
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Telephone | 731-589-3621
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 8909
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License Number State | TN
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