Marya Polan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

62689 Issued in CA

Practice address

1207 Carlsbad Village Dr Ste G
Carlsbad, CA 92008-1958

Phone

(607) 434-1066

NPI assigned

Jun 24, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Marya Vaysburg Former name

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

Practice roles

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.

• Mantena and Ghazal Dental Corporation

  • General Practice Dentistry
  • Vacaville, CA
  • NPI 1043589294
  NPD (past)

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741824000000",
    "number": "1306251855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 NUT TREE PARKWAY",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "95687",
            "telephone_number": "707-451-8390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 CARLSBAD VILLAGE DR STE G",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920081958",
            "telephone_number": "607-434-1066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLAN",
        "first_name": "MARYA",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-24",
        "last_updated": "2025-03-13",
        "certification_date": "2025-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "62689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYA",
            "last_name": "VAYSBURG",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexandra Irene Poblete-Soliven
• Sara Ann Poggi, PA-C
• Lauren Pohl, BS
• Kiley Mae Pohlmann
• John Michael Polak, LAC
• Maile Polancic
• Laci Poland-Wood
• Shoshana Shoshana Polansky
• Alexandra Poling, LCSW
• Arinn Francesca Polinsky, MS, CCC-SLP

• General Practice Dentistry in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; 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.