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General NPI Number Information
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NPI Number | 1992439871
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Entity Type | Individual
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Provider Name | AYUSHI POLA DMD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 201 SECOND AVE
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City | COLLEGEVILLE
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State | PA
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Zip | 19426-3613
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Country | US
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Telephone | 610-502-4669
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Fax |
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Provider Business Mailing Address
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Address Line | 204 TREELINE DR
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City | LANSDALE
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State | PA
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Zip | 19446-6467
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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 |
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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 | DS043765
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License Number State | PA
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