Individual
PRESTON H POLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3740 DACORO LN STE 115, CASTLE ROCK, CO 80109-2510
(303) 660-5576
Mailing address
3740 DACORO LN STE 115, CASTLE ROCK, CO 80109-2510
(303) 660-5576
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN.00010353
CO
1223G0001X
General Practice Dentistry
D3456
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010028786
BLUE SHIELD OF IDAHO
ID
01
—
1362826
UNITED CONCORDIA
—
01
—
6D964
BLUE CROSS OF IDAHO
ID
05
—
806115500
—
ID
Enumeration date
10/02/2006
Last updated
03/30/2022
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