Provider Demographics
NPI:1780185462
Name:KENNETH C. POLLARY DDS PLLC
Entity Type:Organization
Organization Name:KENNETH C. POLLARY DDS PLLC
Other - Org Name:POLLARY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-591-0750
Mailing Address - Street 1:3204 N ACADEMY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5163
Mailing Address - Country:US
Mailing Address - Phone:719-591-0750
Mailing Address - Fax:
Practice Address - Street 1:3204 N ACADEMY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5163
Practice Address - Country:US
Practice Address - Phone:719-591-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty