Elizabeth Ann Poleck, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DS038530 Issued in PA

Practice address

584 Springville Rd
New Holland, PA 17557-9564

Phone

(717) 354-4711

NPI assigned

Mar 29, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Elizabeth Ann Latham Former name

Medicare fee-for-service enrollment

Enrolled in DE

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

Locations

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.

• Southbridge Medical Advisory Council Inc

  • Federally Qualified Health Center (FQHC)
  • Wilmington, DE
  • NPI 1770699621

  Dentist

  Medicare reassignment NPD
• Southbridge Medical Advisory Council, Inc.

  • Federally Qualified Health Center (FQHC)
  • Claymont, DE
  • NPI 1760874549
  NPD
• Southbridge Medical Advisory Council, Inc.

  • Primary Care Clinic/Center
  • Wilmington, DE
  • NPI 1861925042
  NPD

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

{
    "created_epoch": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386806400000",
    "number": "1356630552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "584 SPRINGVILLE RD",
            "city": "NEW HOLLAND",
            "state": "PA",
            "postal_code": "175579564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "584 SPRINGVILLE RD",
            "city": "NEW HOLLAND",
            "state": "PA",
            "postal_code": "175579564",
            "telephone_number": "717-354-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLECK",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-29",
        "last_updated": "2013-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS038530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "LATHAM",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Gina Marie Reppert, PA-C
• Resonance Audiology and Hearing Aid Center, LLC

• Dentist in New Holland, PA
• Providers in New Holland, PA by specialty
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; 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.