Provider Demographics
NPI:1376758557
Name:POLLACK, ALAN SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SCOTT
Last Name:POLLACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 64TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6690
Mailing Address - Country:US
Mailing Address - Phone:212-838-0940
Mailing Address - Fax:212-355-4784
Practice Address - Street 1:225 E 64TH ST STE 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6690
Practice Address - Country:US
Practice Address - Phone:212-838-0940
Practice Address - Fax:212-355-4784
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355721223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133049463OtherFEDERAL TAX ID