Provider Demographics
NPI:1306251855
Name:POLAN, MARYA (DDS)
Entity type:Individual
Prefix:
First Name:MARYA
Middle Name:
Last Name:POLAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARYA
Other - Middle Name:
Other - Last Name:VAYSBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:110 NUT TREE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687
Mailing Address - Country:US
Mailing Address - Phone:707-451-8390
Mailing Address - Fax:
Practice Address - Street 1:1207 CARLSBAD VILLAGE DR STE G
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1958
Practice Address - Country:US
Practice Address - Phone:607-434-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice