MEDICARE: DR. DAWN L POLASKY 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
1	1223G0001X	General Practice Dentistry	DN17394	FL

General Provider Information

NPI Number	:	1144366220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAWN L POLASKY D.D.S.

Provider Business Mailing Address
First Line	:	6231 N FEDERAL HWY
Second Line	:	109
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	954-229-2424
Fax Number	:	954-229-2427

Provider Business Practice Location Address
First Line	:	6231 N FEDERAL HWY
Second Line	:	109
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1903
Country	:	US
Telephone Number	:	954-229-2424
Fax Number	:	954-229-2427

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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