Provider Demographics
NPI:1952312209
Name:JERROLD J. POLLACK,D.D.S.,P.A
Entity Type:Organization
Organization Name:JERROLD J. POLLACK,D.D.S.,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-694-9655
Mailing Address - Street 1:5405 WOODLYN CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6963
Mailing Address - Country:US
Mailing Address - Phone:301-371-7730
Mailing Address - Fax:
Practice Address - Street 1:1133 KESWICK PL
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-6168
Practice Address - Country:US
Practice Address - Phone:301-694-9655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD38101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty