Provider Demographics
NPI:1265573638
Name:RAY L POLLACK & ASSOCIATES DDS PA
Entity type:Organization
Organization Name:RAY L POLLACK & ASSOCIATES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-724-4520
Mailing Address - Street 1:1325 S PINE ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3187
Mailing Address - Country:US
Mailing Address - Phone:321-724-4520
Mailing Address - Fax:321-723-9762
Practice Address - Street 1:1325 S PINE ST
Practice Address - Street 2:SUITE #103
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3187
Practice Address - Country:US
Practice Address - Phone:321-724-4520
Practice Address - Fax:321-723-9762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty