| Doctor Name: | TATYANA NIKOLAEVNA POLEON |
| NPI Number: | 1477993434 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.D. |
| License Number: | DT-DO-10131109 |
| Business Practice Address: | 7931 Ne Halsey St Suite 307 Portland, OR - 972136755 |
| Business Phone Number: | 3602165931 |
| Business Fax Number: | 5032521214 |
| Mailing Address: | 7931 Ne Halsey St, Suite 307 PORTLAND |
| State: | OR |
| Postal Code: | 972136755 |
| Phone Number: | 3602165931 |
| Fax Number: | 5032521214 |
| NPI Enumeration Date: | 07/04/2013 |
| NPI Last Update Date: | 07/04/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | DT-DO-10131109 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |