Provider Demographics
NPI:1124165543
Name:POLLAK, PATRICK PASCAL
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:PASCAL
Last Name:POLLAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BOARDMAN TER
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3306
Mailing Address - Country:US
Mailing Address - Phone:860-729-0017
Mailing Address - Fax:
Practice Address - Street 1:150 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4575
Practice Address - Country:US
Practice Address - Phone:860-749-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0095191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice