Provider Demographics
NPI:1912082983
Name:POLK, ERICA (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:POLK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 ESTATE OFFICE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3626
Mailing Address - Country:US
Mailing Address - Phone:901-590-1404
Mailing Address - Fax:901-328-5575
Practice Address - Street 1:5370 ESTATE OFFICE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3626
Practice Address - Country:US
Practice Address - Phone:901-590-1404
Practice Address - Fax:901-328-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN075521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice