| Polo Dental | |
|
5030 Champion Blvd Ste G4 Boca Raton FL 33496-2478 | |
| (561) 241-7656 | |
| Not Available |
| Full Name | Polo Dental |
|---|---|
| Speciality | Dentist |
| Location | 5030 Champion Blvd Ste G4, Boca Raton, Florida |
| Authorized Official Name and Position | Simon Leizgold (VP) |
| Authorized Official Contact | 5612417656 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Polo Dental 1905 Clint Moore Rd Ste 200 Boca Raton FL 33496-2660 Ph: (561) 241-7656 | Polo Dental 5030 Champion Blvd Ste G4 Boca Raton FL 33496-2478 Ph: (561) 241-7656 |
| NPI Number | 1841579257 |
|---|---|
| Provider Enumeration Date | 08/16/2011 |
| Last Update Date | 09/03/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841579257 | NPI | - | NPPES |
| 1104903301 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN164481 (Florida) | Primary |
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