MEDICARE: NICHOLAS POLCZYNSKI

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
1	122300000X	Dentist	2009014145	MO

General Provider Information

NPI Number	:	1134360472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS POLCZYNSKI

Provider Business Mailing Address
First Line	:	13003 EVERETT CT
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-5311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13003 EVERETT CT
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-5311
Country	:	US
Telephone Number	:	913-683-9941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2009
Last Update Date	:	08/26/2010

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Directions to “ NICHOLAS POLCZYNSKI ” Practice Location

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