Provider Demographics
NPI:1699847871
Name:POLLINA, RUSSELL S (DDS)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:S
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 1:521 W CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6514
Mailing Address - Country:US
Mailing Address - Phone:847-392-2457
Mailing Address - Fax:847-392-6119
Practice Address - Street 1:521 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-6514
Practice Address - Country:US
Practice Address - Phone:847-392-2457
Practice Address - Fax:847-392-6119
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21-0016741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry