Provider Demographics
NPI:1336483825
Name:RUSSELL S. POLLINA D.D.S., PC
Entity Type:Organization
Organization Name:RUSSELL S. POLLINA D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:POLLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-392-2457
Mailing Address - Street 1:601 W. CENTRAL ROAD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MT. PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-392-2457
Mailing Address - Fax:847-392-6119
Practice Address - Street 1:601 W. CENTRAL ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:MT. PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-392-2457
Practice Address - Fax:847-392-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty