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NPI Code Detail

MEDICARE: DR. SCOTT ALAN POLZIN DDS

MEDICARE: DR. SCOTT ALAN POLZIN DDS
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 Dentistry8947MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
146268POOTHERMNBCBS MN
2424113OTHERMNUNITED CONCORDIA
3HP37188OTHERMNHEALTH PARTNERS
4904481008109OTHERMNPREFERRED ONE

General Provider Information

NPI Number : 1699868745
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT ALAN POLZIN DDS
Provider Business Mailing Address
First Line : 1225 E 1ST ST
Second Line :
City : DULUTH
State : MN
Zip : 55805-2402
Country : US
Telephone Number : 218-728-6445
Fax Number : 218-724-7003
Provider Business Practice Location Address
First Line : 1225 E 1ST ST
Second Line :
City : DULUTH
State : MN
Zip : 55805-2402
Country : US
Telephone Number : 218-728-6445
Fax Number : 218-724-7003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 10/30/2007

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