MEDICARE: ADAM POLAN DMD

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	1223G0001X	General Practice Dentistry	DE60123701	WA
2	1223G0001X	General Practice Dentistry	D9383	OR

General Provider Information

NPI Number	:	1902136989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM POLAN DMD

Provider Business Mailing Address
First Line	:	3514 NE BROADWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1821
Country	:	US
Telephone Number	:	503-284-1602
Fax Number	:	503-284-1602

Provider Business Practice Location Address
First Line	:	3514 NE BROADWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1821
Country	:	US
Telephone Number	:	503-284-1602
Fax Number	:	503-284-1602

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

Provider Enumeration Date	:	01/13/2010
Last Update Date	:	10/11/2023

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Directions to “ ADAM POLAN DMD” Practice Location

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