Provider Demographics
NPI:1912967308
Name:POLLOCK, VERNON W (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:W
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 E MESQUITE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-4791
Mailing Address - Country:US
Mailing Address - Phone:702-345-2772
Mailing Address - Fax:702-345-3340
Practice Address - Street 1:21 E MESQUITE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-4791
Practice Address - Country:US
Practice Address - Phone:702-345-2772
Practice Address - Fax:702-345-3340
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics