Mark A Polentz, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

30820 Issued in CA

Practice address

350 N McKinley St Ste 101
Corona, CA 92879-6503

Phone

(951) 736-1215

NPI assigned

Aug 15, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218758400000",
    "number": "1265688790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N MCKINLEY ST STE 101",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928796503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 N MCKINLEY ST STE 101",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928796503",
            "telephone_number": "951-736-1215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLENTZ",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-15",
        "last_updated": "2008-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "30820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Marie Plumb, MD
• PNT Nguyen Dental Corporation
• Maynard Pogue, DDS
• Samantha Poirier
• Christina Poland, PMHNP
• Rahul Dev Polineni, M.D
• Elisa Polino
• Edward J Politoske, MD
• Nicole Polk
• William Pollock, PA-C

• Dentist in Corona, CA
• Providers in Corona, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.