Jim H Polles, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

3402-06 Issued in MS

Practice address

1836 Crane Ridge Dr
Suite a
Jackson, MS 39216-4901

Phone

(601) 362-1118

Fax

(601) 362-3113

NPI assigned

Aug 8, 2006

Sex

Male

Sole proprietor

Yes

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.

• Decatur Dental, LLC

  • Dental Clinic/Center
  • Decatur, MS
  • NPI 1073985925
  NPD (past) Authorized official
• Jim H. Polles, D.M.D., P.a.

  • Dental Clinic/Center
  • Jackson, MS
  • NPI 1720413768
  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 7, 2010.

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270598400000",
    "number": "1669482014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 CRANE RIDGE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164901",
            "telephone_number": "601-362-1118",
            "fax_number": "601-362-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1836 CRANE RIDGE DR",
            "address_2": "SUITE A",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164901",
            "telephone_number": "601-362-1118",
            "fax_number": "601-362-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLES",
        "first_name": "JIM",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2010-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "7754",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3402-06",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "260182567",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "223877136",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Latonya Polk, CMHT
• Polk'S Crossgates Discount Drugs Inc.
• Katherine Pollan
• J. Daryl Pollard, M.D.
• Jasmine Pollard
• Steven Miles Pollock, D.M.D.
• James R Polson, NP-C
• Pawel T Pomianowski, M.D.
• Aaron Randy Poole, MD, PHD
• Jackson W. Pope, MD

• All providers in Jackson, MS
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.