Provider Demographics
NPI:1609978881
Name:GLENN M POCH DDS LLC
Entity Type:Organization
Organization Name:GLENN M POCH DDS LLC
Other - Org Name:BLUE WATER DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:POCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-674-3000
Mailing Address - Street 1:2288 BLUE WATER BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113
Mailing Address - Country:US
Mailing Address - Phone:410-674-3000
Mailing Address - Fax:410-674-7000
Practice Address - Street 1:2288 BLUE WATER BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113
Practice Address - Country:US
Practice Address - Phone:410-674-3000
Practice Address - Fax:410-674-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty