Provider Demographics
NPI:1548301906
Name:POLLOCK, RAYMOND LYLE (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LYLE
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1325 SOUTH PINE ST
Mailing Address - Street 2:#103
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3187
Mailing Address - Country:US
Mailing Address - Phone:321-724-4520
Mailing Address - Fax:321-723-9762
Practice Address - Street 1:1325 SOUTH PINE ST
Practice Address - Street 2:#103
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3187
Practice Address - Country:US
Practice Address - Phone:321-724-4520
Practice Address - Fax:321-723-9762
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN69541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry