Nino Demetrius Pollaccia, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D010824 Issued in AZ

Practice address

10210 W Happy Valley Pkwy Ste 150
Peoria, AZ 85383-2881

Phone

(623) 230-2297

Fax

(623) 239-3547

NPI assigned

Apr 2, 2007

Last updated

Apr 8, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24909/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Peoria Oral & Implant Surgery PLLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Peoria, AZ
  • NPI 1497265516
  NPD Authorized official
• Just Wisdom Teeth Westminster

  • Dentist
  • Westminster, CO
  • NPI 1649515453
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1356462188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10210 W HAPPY VALLEY PKWY STE 150",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853832881",
            "telephone_number": "623-230-2297",
            "fax_number": "623-239-3547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10210 W HAPPY VALLEY PKWY STE 150",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853832881",
            "telephone_number": "623-230-2297",
            "fax_number": "623-239-3547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLLACCIA",
        "first_name": "NINO",
        "middle_name": "DEMETRIUS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CO",
            "license": "8941",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D010824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• PM Schap MD PC
• PMC Pain Management Center PLLC
• Meghan Poach, OTD, OTR/L
• Alyssa Kay Poland, PA-C
• Lindsay Polk, PSY.D.
• Thomas Weldon Pollard, DO
• Stevan A Polus
• Polyclinic Pharmacy Inc. (A2Z DME)
• Shelby Poole
• Dorin T Popa, MD

• Oral and Maxillofacial Surgery (Dentist) in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.