Mariano Andres Polack, DDS, MS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

0401410556 Issued in VA

Practice address

7431 New Linton Hall Rd
Gainesville, VA 20155

Phone

(703) 753-8753

NPI assigned

Jul 23, 2007

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 3, 2019 through Jan 3, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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.

• DRS. Polack and Olano, PC

  • General Practice Dentistry
  • Gainesville, VA
  • NPI 1700060712

  Prosthodontics

  NPD (past) Authorized official

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

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185148800000",
    "number": "1679773188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7431 NEW LINTON HALL RD",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "20155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7431 NEW LINTON HALL RD",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "20155",
            "telephone_number": "703-753-8753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLACK",
        "first_name": "MARIANO",
        "middle_name": "ANDRES",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-23",
        "last_updated": "2007-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "VA",
            "license": "0401410556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faline Phucas Davenport
• Michael R Pichardo, DDS
• Piedmont Professional Counseling
• Cecille M Pineda, PHARMD
• Jean Marie Pitt, CNA
• Veronica Delatorre Porterfield, PA-C
• Potomac Behavioral Health LLC
• Anne Powell, FNP
• Powerback Rehabilitation LLC
• Premier Medical Transport LLC

• Prosthodontics in Gainesville, VA
• Providers in Gainesville, VA by specialty
• Prosthodontics in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.