Provider Demographics
NPI:1528137098
Name:POLAN, MARSHALL A (DDS)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:A
Last Name:POLAN
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 1:75 NEW ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3365
Mailing Address - Country:US
Mailing Address - Phone:631-423-5533
Mailing Address - Fax:631-423-5535
Practice Address - Street 1:75 NEW ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3365
Practice Address - Country:US
Practice Address - Phone:631-423-5533
Practice Address - Fax:631-423-5535
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027696-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice