Provider Demographics
NPI:1316164387
Name:POLHEMUS, DAVID G (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:POLHEMUS
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 1:8001 CREEDMOOR RD STE 211
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5692
Mailing Address - Country:US
Mailing Address - Phone:919-870-7104
Mailing Address - Fax:
Practice Address - Street 1:8001 CREEDMOOR RD STE 211
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-5692
Practice Address - Country:US
Practice Address - Phone:919-870-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC97024OtherBCBSNC