Provider Demographics
NPI:1962462135
Name:POLK, AARON CHRISTOPHER (DDS)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:CHRISTOPHER
Last Name:POLK
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 1:211 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965
Mailing Address - Country:US
Mailing Address - Phone:936-564-2417
Mailing Address - Fax:936-560-0083
Practice Address - Street 1:211 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965
Practice Address - Country:US
Practice Address - Phone:936-564-2417
Practice Address - Fax:936-560-0083
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20669122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU95202Medicare ID - Type Unspecified
TXU95202Medicare UPIN