MEDICARE: BRIAN POLILLO 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	122300000X	Dentist	DE60439325	WA

General Provider Information

NPI Number	:	1497177042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN POLILLO D.D.S

Provider Business Mailing Address
First Line	:	16810 MERIDIAN E
Second Line	:	SUITE J107
City	:	PUYALLUP
State	:	WA
Zip	:	98375-9604
Country	:	US
Telephone Number	:	253-848-7777
Fax Number	:	253-848-7783

Provider Business Practice Location Address
First Line	:	16810 MERIDIAN E
Second Line	:	SUITE J107
City	:	PUYALLUP
State	:	WA
Zip	:	98375-9604
Country	:	US
Telephone Number	:	253-848-7777
Fax Number	:	253-848-7783

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

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	01/16/2014

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Directions to “ BRIAN POLILLO D.D.S” Practice Location

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