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NPI Code Detail

MEDICARE: DR. REGINA LYNN POLK D.D.S.

MEDICARE: DR. REGINA LYNN POLK 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
11223G0001XGeneral Practice Dentistry18146TX

General Provider Information

NPI Number : 1619022787
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REGINA LYNN POLK D.D.S.
Provider Business Mailing Address
First Line : 220 COMMERCIAL DR STE B
Second Line : 156
City : HARKER HEIGHTS
State : TX
Zip : 76548-2566
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4431 68TH ST
Second Line :
City : FORT HOOD
State : TX
Zip : 76544-5042
Country : US
Telephone Number : 254-287-2705
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2007
Last Update Date : 06/08/2016

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