Provider Demographics
NPI:1447972567
Name:ELLEN POLSKY, DDS
Entity type:Organization
Organization Name:ELLEN POLSKY, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:POLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-486-8068
Mailing Address - Street 1:10317 122ND ST E STE A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2632
Mailing Address - Country:US
Mailing Address - Phone:206-486-8068
Mailing Address - Fax:
Practice Address - Street 1:15819 WESTMINSTER WAY N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5928
Practice Address - Country:US
Practice Address - Phone:206-486-8068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental