=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255657565
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW DIMENSIONS DENTISTRY AND ORTHODONTICS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2010
-----------------------------------------------------
Last Update Date | 04/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1253 SCALP AVE SUITE 105
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15904-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-269-9731
-----------------------------------------------------
Fax | 814-266-5881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1253 SCALP AVE SUITE 105
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15904-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-269-9731
-----------------------------------------------------
Fax | 814-266-5881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. SAMUEL CHARLES POLLINA
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 814-269-9731
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS-023871-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------