Provider Demographics
NPI:1104909589
Name:POLLAK, MARTHA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
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 1:2542 WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3240
Mailing Address - Country:US
Mailing Address - Phone:626-814-2766
Mailing Address - Fax:626-917-3009
Practice Address - Street 1:ORAL RADIOLOGY SCHOOL OF DENTISTRY
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:626-814-2766
Practice Address - Fax:626-917-3009
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist