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NPI Code Detail

MEDICARE: DR. MARIO EDUARDO POLANCO D.D.S.

MEDICARE: DR. MARIO EDUARDO POLANCO D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN16816FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023065315
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIO EDUARDO POLANCO D.D.S.
Provider Business Mailing Address
First Line : 8704 SLEEPY OAK PL
Second Line :
City : TAMPA
State : FL
Zip : 33614-1770
Country : US
Telephone Number : 813-405-3939
Fax Number : 813-405-3929
Provider Business Practice Location Address
First Line : 7814 N DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33614-3220
Country : US
Telephone Number : 813-405-3939
Fax Number : 813-405-3929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2006
Last Update Date : 01/03/2011

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