Provider Demographics
NPI:1093161440
Name:POLLEY, DENNIS II (PA-C)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:POLLEY
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 GLENDALE DRIVE
Mailing Address - Street 2:POLLEY CLINIC OF DERMATOLOGY
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4402
Mailing Address - Country:US
Mailing Address - Phone:252-243-0566
Mailing Address - Fax:252-243-1347
Practice Address - Street 1:106 BARCELONA DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4453
Practice Address - Country:US
Practice Address - Phone:252-243-0566
Practice Address - Fax:252-243-1347
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06370363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-06370OtherNC MEDICAL BOARD
NC0010-06370OtherNC MEDICAL BOARD