Provider Demographics
NPI:1609923036
Name:POLLARD, JOHN J (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:POLLARD
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 1:2609 MEADOW CREEK CIR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7112
Mailing Address - Country:US
Mailing Address - Phone:701-234-9602
Mailing Address - Fax:
Practice Address - Street 1:1221 HARWOOD DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4604
Practice Address - Country:US
Practice Address - Phone:701-235-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND18121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice