Provider Demographics
NPI:1699828558
Name:POCH, GLENN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:MICHAEL
Last Name:POCH
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 1:2288 BLUE WATER BLVD STE 420
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3309
Mailing Address - Country:US
Mailing Address - Phone:410-674-3000
Mailing Address - Fax:410-674-7000
Practice Address - Street 1:2288 BLUE WATER BLVD STE 420
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3309
Practice Address - Country:US
Practice Address - Phone:410-674-3000
Practice Address - Fax:410-674-7000
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist