Provider Demographics
NPI:1427030287
Name:POLLINA, SAMUEL CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CHARLES
Last Name:POLLINA
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 1:1253 SCALP AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904
Mailing Address - Country:US
Mailing Address - Phone:814-269-9731
Mailing Address - Fax:814-266-5881
Practice Address - Street 1:1253 SCALP AVE
Practice Address - Street 2:STE 105
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904
Practice Address - Country:US
Practice Address - Phone:814-269-9731
Practice Address - Fax:814-266-5881
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023871L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA446443OtherUNITED CONCORDIA
67923OtherTHREE RIVERS MED PLUS
PA01551950Medicaid
PA244771OtherGATEWAY HEALTH PLAN
66823OtherUPMC