Provider Demographics
NPI:1548640857
Name:POLASEK, STEVEN KYLE (DDS)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:KYLE
Last Name:POLASEK
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 1:917 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1309
Mailing Address - Country:US
Mailing Address - Phone:517-543-1840
Mailing Address - Fax:517-543-8780
Practice Address - Street 1:917 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1309
Practice Address - Country:US
Practice Address - Phone:517-543-1840
Practice Address - Fax:517-543-8780
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist