Provider Demographics
NPI:1316043599
Name:POLLER, RICHARD C (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:POLLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9313
Mailing Address - Country:US
Mailing Address - Phone:908-686-5868
Mailing Address - Fax:908-686-2331
Practice Address - Street 1:459 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9313
Practice Address - Country:US
Practice Address - Phone:908-686-5868
Practice Address - Fax:908-686-2331
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice