Provider Demographics
NPI:1790907590
Name:POLLI, DENNIS MICHAEL (IDC)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:POLLI
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-5961
Mailing Address - Country:US
Mailing Address - Phone:757-462-4316
Mailing Address - Fax:
Practice Address - Street 1:1575 GATOR BLVD BLDG 3504
Practice Address - Street 2:NAB LITTLE CREEK
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-2739
Practice Address - Country:US
Practice Address - Phone:757-462-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman