Provider Demographics
NPI:1174570048
Name:ALAN M. POLSE D.D.S. & ASSOCIATES, LTD.
Entity type:Organization
Organization Name:ALAN M. POLSE D.D.S. & ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:MERLIN
Authorized Official - Last Name:POLSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-888-8108
Mailing Address - Street 1:2000 LARKIN AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4404
Mailing Address - Country:US
Mailing Address - Phone:847-888-8108
Mailing Address - Fax:847-888-8170
Practice Address - Street 1:2000 LARKIN AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4404
Practice Address - Country:US
Practice Address - Phone:847-888-8108
Practice Address - Fax:847-888-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19156491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty