Healthcare Provider Details

I. General information

NPI: 1851309892
Provider Name (Legal Business Name): LEE DAVID POLLAN DMD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CLINTON AVE S BLDG H SUITE 125
ROCHESTER NY
14618-2668
US

IV. Provider business mailing address

2400 CLINTON AVE S BLDG H SUITE 125
ROCHESTER NY
14618-2668
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-7314
  • Fax: 585-341-7320
Mailing address:
  • Phone: 585-341-7314
  • Fax: 585-341-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number030785
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: