MEDICARE: MRS. RUTH PENTON POLSON DMD

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	5186	AL

General Provider Information

NPI Number	:	1598890725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTH PENTON POLSON DMD

Provider Business Mailing Address
First Line	:	3145 GREEN VALLEY ROAD
Second Line	:	SUITE 101
City	:	VESTANA HILLS
State	:	AL
Zip	:	35243
Country	:	US
Telephone Number	:	205-970-7292
Fax Number	:	205-623-3036

Provider Business Practice Location Address
First Line	:	3145 GREEN VALLEY ROAD
Second Line	:	SUITE 101
City	:	VESTANA HILLS
State	:	AL
Zip	:	35243
Country	:	US
Telephone Number	:	205-970-7292
Fax Number	:	205-623-3036

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	02/02/2017

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