Provider Demographics
NPI:1851309892
Name:POLLAN, LEE DAVID (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:DAVID
Last Name:POLLAN
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2400 CLINTON AVE S
Mailing Address - Street 2:BLDG H SUITE 125
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2668
Mailing Address - Country:US
Mailing Address - Phone:585-341-7314
Mailing Address - Fax:585-341-7320
Practice Address - Street 1:2400 CLINTON AVE S
Practice Address - Street 2:BLDG H SUITE 125
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2668
Practice Address - Country:US
Practice Address - Phone:585-341-7314
Practice Address - Fax:585-341-7320
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0307851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00479341Medicaid
NY17192BMedicare PIN
T88447Medicare UPIN