Healthcare Provider Details

I. General information

NPI: 1134339054
Provider Name (Legal Business Name): ROBERT A . POLLARA,DDS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MADISON AVE
MORRISTOWN NJ
07960-6013
US

IV. Provider business mailing address

110 MADISON AVE
MORRISTOWN NJ
07960-6013
US

V. Phone/Fax

Practice location:
  • Phone: 973-267-7011
  • Fax: 973-267-7011
Mailing address:
  • Phone: 973-267-7011
  • Fax: 973-267-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8740
License Number StateNJ

VIII. Authorized Official

Name: DR. ROBERT ALFRED POLLARA
Title or Position: PRESIDENT
Credential: DDS
Phone: 973-267-7011