Basic Information
Provider Information
NPI: 1669703898
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POLLACK
FirstName: SABRINA
MiddleName: N
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2860 MICHELLE
Address2: 2ND FLOOR
City: IRVINE
State: CA
PostalCode: 926061009
CountryCode: US
TelephoneNumber: 7143682077
FaxNumber: 7143682092
Practice Location
Address1: 422 ORANGE ST
Address2:  
City: REDLANDS
State: CA
PostalCode: 923743206
CountryCode: US
TelephoneNumber: 9097927500
FaxNumber: 9097927503
Other Information
ProviderEnumerationDate: 01/28/2010
LastUpdateDate: 01/28/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X54292CAY Dental ProvidersDentist 

No ID Information.


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