MEDICARE: DR. AYUSHI POLA 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	DS043765	PA

General Provider Information

NPI Number	:	1992439871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYUSHI POLA DMD

Provider Business Mailing Address
First Line	:	204 TREELINE DR
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-6467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SECOND AVE
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-3613
Country	:	US
Telephone Number	:	610-502-4669
Fax Number	:

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

Provider Enumeration Date	:	07/15/2022
Last Update Date	:	07/15/2022

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