Provider Demographics
NPI:1144586496
Name:MICHAEL J POLLOCK DDS INC
Entity Type:Organization
Organization Name:MICHAEL J POLLOCK DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-423-9471
Mailing Address - Street 1:3721 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044
Mailing Address - Country:US
Mailing Address - Phone:513-423-9471
Mailing Address - Fax:513-423-5116
Practice Address - Street 1:3721 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6514
Practice Address - Country:US
Practice Address - Phone:513-423-9471
Practice Address - Fax:513-423-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty