Philip G. Polus, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12008055A Issued in IN

Practice address

1549 S Court St
Crown Point, IN 46307-4809

Phone

(219) 662-0131

Fax

(219) 662-3962

NPI assigned

Jun 14, 2006

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 IN

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.

• Polus Dental

  • General Practice Dentistry
  • Crown Point, IN
  • NPI 1083707566
  NPD (past) Authorized official

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430092800000",
    "number": "1669415063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1549 S COURT ST",
            "address_2": "STE B",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463074809",
            "telephone_number": "219-662-0131",
            "fax_number": "219-662-3962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1549 S COURT ST",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463074809",
            "telephone_number": "219-662-0131",
            "fax_number": "219-662-3962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLUS",
        "first_name": "PHILIP",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2015-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12008055A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Polezoes, M.D.
• Shannon Polezoes
• Sophia Pollalis, ATC
• Polus Dental
• Alexandra Polus, D.M.D.
• Iryna Vitaliyivna Polyakova, D.O.
• Lexi Popko, RBT
• Popovich Dental Corporation
• Ashley Marie Popovich, NP-C
• James Gabriel Popovich, D.D.S

• Dentist in Crown Point, IN
• Providers in Crown Point, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; 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.