Healthcare Provider Details

I. General information

NPI: 1881748739
Provider Name (Legal Business Name): GINGER M POLLACK DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 BOSTON TURNPIKE
BOLTON CT
06043
US

IV. Provider business mailing address

PO BOX 9488
BOLTON CT
06043
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-0773
  • Fax: 860-647-6915
Mailing address:
  • Phone: 860-646-0773
  • Fax: 860-647-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8985
License Number StateCT

VIII. Authorized Official

Name: GINGER M POLLACK
Title or Position: PRESIDENT
Credential: DMD
Phone: 860-646-0773