Provider Demographics
NPI:1699868745
Name:POLZIN, SCOTT ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:POLZIN
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 1:1225 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2402
Mailing Address - Country:US
Mailing Address - Phone:218-728-6445
Mailing Address - Fax:218-724-7003
Practice Address - Street 1:1225 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2402
Practice Address - Country:US
Practice Address - Phone:218-728-6445
Practice Address - Fax:218-724-7003
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN89471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN46268POOtherBCBS MN
MN424113OtherUNITED CONCORDIA
MNHP37188OtherHEALTH PARTNERS
MN904481008109OtherPREFERRED ONE