Provider Demographics
NPI:1659329175
Name:POLLOCK, GEORGE KEVIN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KEVIN
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 WEST RALPH HALL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6660
Mailing Address - Country:US
Mailing Address - Phone:469-698-9800
Mailing Address - Fax:469-698-9804
Practice Address - Street 1:960 WEST RALPH HALL PARKWAY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6660
Practice Address - Country:US
Practice Address - Phone:469-698-9800
Practice Address - Fax:469-698-9804
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167361223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU62372Medicare UPIN
TX155027902Medicaid
TX8506B6Medicare ID - Type Unspecified