Provider Demographics
NPI:1922488071
Name:POLKINHORN, KAITLAN (DDS)
Entity type:Individual
Prefix:
First Name:KAITLAN
Middle Name:
Last Name:POLKINHORN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88D UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3219
Mailing Address - Country:US
Mailing Address - Phone:775-225-4714
Mailing Address - Fax:
Practice Address - Street 1:88D UNION AVE
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3219
Practice Address - Country:US
Practice Address - Phone:775-225-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060162-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist