Provider Demographics
NPI:1376513705
Name:POLLOCK, GLENN B (DMD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:B
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4664 W WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329
Mailing Address - Country:US
Mailing Address - Phone:248-674-0418
Mailing Address - Fax:248-674-4518
Practice Address - Street 1:4664 W WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329
Practice Address - Country:US
Practice Address - Phone:248-674-0418
Practice Address - Fax:248-674-4518
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0102611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics