MEDICARE: DR. JIM H POLLES D.M.D.

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	7754	TN
2	122300000X	Dentist	3402-06	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260182567	OTHER	MS	TAX ID
2	223877136	OTHER	TN	TAX ID

General Provider Information

NPI Number	:	1669482014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIM H POLLES D.M.D.

Provider Business Mailing Address
First Line	:	1836 CRANE RIDGE DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4901
Country	:	US
Telephone Number	:	601-362-1118
Fax Number	:	601-362-3113

Provider Business Practice Location Address
First Line	:	1836 CRANE RIDGE DR
Second Line	:	SUITE A
City	:	JACKSON
State	:	MS
Zip	:	39216-4901
Country	:	US
Telephone Number	:	601-362-1118
Fax Number	:	601-362-3113

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	04/07/2010

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Directions to “ DR. JIM H POLLES D.M.D.” Practice Location

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