Healthcare Provider Details

I. General information

NPI: 1619084951
Provider Name (Legal Business Name): MICHAEL JOHN POLLOCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721ROOSEVELT BLVD, MIDDLETOWN OH 45044
MIDDLETOWN OH
45044
US

IV. Provider business mailing address

3721ROOSEVELT BLVD, MIDDLETOWN OH 45044
MIDDLETOWN OH
45044
US

V. Phone/Fax

Practice location:
  • Phone: 513-423-9471
  • Fax: 513-423-5116
Mailing address:
  • Phone: 513-423-9471
  • Fax: 513-423-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30015504
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: