MEDICARE: JIM H. POLLES, D.M.D., P.A.

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	3402-06	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720413768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIM H. POLLES, D.M.D., P.A.

Provider Business Mailing 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

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	:	OWNER/DENTIST
Name	:	DR. JIM H POLLES
Credential	:	D.M.D.
Telephone Number	:	601-362-1118

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	09/10/2013

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Directions to “JIM H. POLLES, D.M.D., P.A. ” Practice Location

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