MEDICARE: DR. BRIAN J POLIDORI 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	00009836	CO

General Provider Information

NPI Number	:	1164576450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN J POLIDORI DDS

Provider Business Mailing Address
First Line	:	22701 ANN ARBOR TRL
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2574
Country	:	US
Telephone Number	:	313-274-4422
Fax Number	:

Provider Business Practice Location Address
First Line	:	6565 W JEWELL AVE STE 1A
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-7102
Country	:	US
Telephone Number	:	303-935-3465
Fax Number	:	303-935-8322

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	06/12/2023

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