| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 2326 5th Ave, Seattle, Washington |
| Authorized Official Name and Position | Brian R Polillo (OWNER) |
| Authorized Official Contact | 2064949050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
17000 Red Hill Ave Irvine CA 92614-5626 Ph: (714) 845-8890 | 2326 5th Ave Seattle WA 98121 Ph: (206) 494-9050 |
| NPI Number | 1154862761 |
|---|---|
| Provider Enumeration Date | 03/15/2017 |
| Last Update Date | 04/10/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154862761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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