Provider Demographics
NPI:1528381266
Name:POLLINA, RAYMOND A (DDS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:A
Last Name:POLLINA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S NORTHWEST HWY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4216
Mailing Address - Country:US
Mailing Address - Phone:847-823-4161
Mailing Address - Fax:847-823-4163
Practice Address - Street 1:350 S NORTHWEST HWY
Practice Address - Street 2:SUITE 116
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4216
Practice Address - Country:US
Practice Address - Phone:847-823-4161
Practice Address - Fax:847-823-4163
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A14137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist