Active NPI
Ellen Polsky, DDS.
- Pediatric Dentistry
- Puyallup, WA
National Provider Identifier
1174791529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DE00010757
- Practice address
- 9317 113TH St E
Suite a
Puyallup, WA 98373 - Phone
- (253) 848-7000
- Fax
- (253) 604-0598
- NPI assigned
- Feb 19, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DE00010757 | WA | Primary |
Addresses
Primary practice location
9317 113TH St E
Suite a
Puyallup, WA 98373
Mailing address
9317 113TH St E
Suite a
Puyallup, WA 98373
Phone (253) 848-7000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5054747 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00010757 | WA | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Center Pediatric Dentistry and Orthodontics LLC | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Tukwila, WA
- NPI 1275996191
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463961600000",
"number": "1174791529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9317 113TH ST E",
"address_2": "SUITE A",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "98373",
"telephone_number": "253-848-7000",
"fax_number": "253-604-0598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9317 113TH ST E",
"address_2": "SUITE A",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "98373",
"telephone_number": "253-848-7000",
"fax_number": "253-604-0598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLSKY",
"first_name": "ELLEN",
"name_prefix": "Dr.",
"credential": "DDS.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-19",
"last_updated": "2016-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "WA",
"license": "DE00010757",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5054747",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.