Provider Demographics
NPI:1841405750
Name:POLLOCK, TERA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERA
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:F
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:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-1490
Mailing Address - Country:US
Mailing Address - Phone:972-475-0301
Mailing Address - Fax:972-463-3849
Practice Address - Street 1:4518 ROWLETT RD
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5081
Practice Address - Country:US
Practice Address - Phone:972-475-0301
Practice Address - Fax:972-463-3849
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice