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General NPI Number Information
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NPI Number | 1104909589
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Entity Type | Individual
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Provider Name | MARTHA POLLAK DDS
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ORAL RADIOLOGY SCHOOL OF DENTISTRY UNIVERSITY OF CALIFORNIA
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone | 626-814-2766
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Fax | 626-917-3009
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Provider Business Mailing Address
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Address Line | 2542 WESTWOOD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064-3240
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Country | US
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Telephone | 626-814-2766
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Fax | 626-917-3009
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 32383
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License Number State | CA
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