Provider Demographics
NPI:1134143241
Name:POLLACK, JERROLD JEROME (DDS RPH)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:JEROME
Last Name:POLLACK
Suffix:
Gender:M
Credentials:DDS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 WOODLYN CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6963
Mailing Address - Country:US
Mailing Address - Phone:301-371-7730
Mailing Address - Fax:
Practice Address - Street 1:1700 REISTERSTOWN RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1416
Practice Address - Country:US
Practice Address - Phone:800-659-7828
Practice Address - Fax:410-653-7303
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6505183500000X
MD38101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics