Provider Demographics
NPI:1487758561
Name:POLLAK, ELIZABETH SUSANA (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SUSANA
Last Name:POLLAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4197 DOGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2848
Mailing Address - Country:US
Mailing Address - Phone:562-598-5671
Mailing Address - Fax:
Practice Address - Street 1:5175 E PACIFIC COAST HWY
Practice Address - Street 2:#203
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3317
Practice Address - Country:US
Practice Address - Phone:562-597-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice