Provider Demographics
NPI:1649291394
Name:POLLEY, DENNIS (DO)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:POLLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 GLENDALE DR SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4402
Mailing Address - Country:US
Mailing Address - Phone:252-243-0566
Mailing Address - Fax:252-243-1347
Practice Address - Street 1:1806 GLENDALE DR SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4402
Practice Address - Country:US
Practice Address - Phone:252-243-0566
Practice Address - Fax:252-243-1347
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27881207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2222414OtherFIRST HEALTH
NC99494OtherMEDCOST
NC68327OtherACCORDIA
NC7068303OtherCIGNA
NC7257619OtherAETNA
NC68327OtherBCBS OF NC
NC8968327Medicaid
NCC86019Medicare UPIN
NC8968327Medicaid