Provider Demographics
NPI:1487813069
Name:POLSKY, EDWARD SAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SAUL
Last Name:POLSKY
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 1:8256 JOG ROAD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472
Mailing Address - Country:US
Mailing Address - Phone:561-742-4255
Mailing Address - Fax:561-742-4246
Practice Address - Street 1:8256 JOG ROAD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472
Practice Address - Country:US
Practice Address - Phone:561-742-4255
Practice Address - Fax:561-742-4246
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL4005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist