Healthcare Provider Details

I. General information

NPI: 1770576001
Provider Name (Legal Business Name): SHARON ANN POLLICK DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PATCHOGUE YAPHANK RD SUITE 10
EAST PATCHOGUE NY
11772-4800
US

IV. Provider business mailing address

250 PATCHOGUE YAPHANK RD SUITE 10
EAST PATCHOGUE NY
11772-4800
US

V. Phone/Fax

Practice location:
  • Phone: 631-289-0678
  • Fax:
Mailing address:
  • Phone: 631-289-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number042732
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: