MEDICARE: DR. EITAN JOSEPH POLSTER DDS

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	30025054	OH

General Provider Information

NPI Number	:	1134656689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EITAN JOSEPH POLSTER DDS

Provider Business Mailing Address
First Line	:	2274 HALCYON RD
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-1376
Country	:	US
Telephone Number	:	216-337-7647
Fax Number	:

Provider Business Practice Location Address
First Line	:	7123 PEARL RD STE 100
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-4944
Country	:	US
Telephone Number	:	440-888-6783
Fax Number	:

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

Provider Enumeration Date	:	05/15/2017
Last Update Date	:	05/15/2017

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