Provider Demographics
NPI:1104942333
Name:POLAND, PATRICK DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DAVID
Last Name:POLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34501 AURORA RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3873
Mailing Address - Country:US
Mailing Address - Phone:330-425-1664
Mailing Address - Fax:
Practice Address - Street 1:34501 AURORA RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3873
Practice Address - Country:US
Practice Address - Phone:440-248-0868
Practice Address - Fax:440-248-9467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-13311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice