Healthcare Provider Details

I. General information

NPI: 1134143241
Provider Name (Legal Business Name): JERROLD JEROME POLLACK DDS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 REISTERSTOWN RD SUITE 206
BALTIMORE MD
21208-1416
US

IV. Provider business mailing address

5405 WOODLYN CT
FREDERICK MD
21703-6963
US

V. Phone/Fax

Practice location:
  • Phone: 800-659-7828
  • Fax: 410-653-7303
Mailing address:
  • Phone: 301-371-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6505
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3810
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: