Individual
DR. JASON L POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D. M. D
Contact information
Practice address
120 SCARBROUGH ST, SUITE B, RICHLAND, MS 39218-9770
(601) 932-0606
(601) 932-0703
Mailing address
PO BOX 180607, RICHLAND, MS 39218-0607
(601) 932-0606
(601) 932-0703
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3137
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660432
—
MS
05
—
00660433
—
MS
05
—
09016079
—
MS
Enumeration date
07/24/2006
Last updated
07/09/2007
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