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Organization

PEORIA ORAL & IMPLANT SURGERY PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NINO POLLACCIA DDS (OWNER)
(623) 230-2297
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center

Other

Enumeration date
10/03/2017
Last updated
03/24/2022
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