# PEORIA ORAL & IMPLANT SURGERY PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497265516
- **Authorized official:** NINO POLLACCIA DDS (OWNER)
- **Authorized official phone:** (623) 230-2297

## Contact information

- **Practice address:** 10210 W HAPPY VALLEY PKWY STE 150, PEORIA, AZ 85383-2881
- **Practice address phone:** (623) 230-2297
- **Mailing address:** 7926 W EMORY LN, PEORIA, AZ 85383-1024
- **Mailing address phone:** (720) 470-1091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |
| 261QS0112X | Oral and Maxillofacial Surgery Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/03/2017
- **Last updated:** 03/24/2022