MEDICARE: CHRISTY POLIDORO

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	124Q00000X	Dental Hygienist	H5301	AZ

General Provider Information

NPI Number	:	1841370897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY POLIDORO

Provider Business Mailing Address
First Line	:	413 E VAUGHN AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-6451
Country	:	US
Telephone Number	:	480-206-7682
Fax Number	:

Provider Business Practice Location Address
First Line	:	3336 E CHANDLER HEIGHTS RD
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-4259
Country	:	US
Telephone Number	:	480-813-3636
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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Directions to “ CHRISTY POLIDORO ” Practice Location

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