Provider Demographics
NPI:1174937544
Name:ROSSIGNOL, ILONA POLUR (DMD)
Entity type:Individual
Prefix:DR
First Name:ILONA
Middle Name:POLUR
Last Name:ROSSIGNOL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 DUNNELL RD
Mailing Address - Street 2:313
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2666
Mailing Address - Country:US
Mailing Address - Phone:347-834-3500
Mailing Address - Fax:
Practice Address - Street 1:547 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2107
Practice Address - Country:US
Practice Address - Phone:908-233-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057498-11223X0400X
NJ22DI024858001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics