MEDICARE: DR.POLES DENTAL GROUP INC.

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1538702436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR.POLES DENTAL GROUP INC.

Provider Business Mailing Address
First Line	:	305 E RAND RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 E RAND RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3103
Country	:	US
Telephone Number	:	847-241-4161
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BILUS POLES
Credential	:	DDS
Telephone Number	:	847-241-4161

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	10/23/2019

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