Healthcare Provider Details

I. General information

NPI: 1033762323
Provider Name (Legal Business Name): JOSHUA DAVID POLLACK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E TATUM AVE
MC COLL SC
29570-2323
US

IV. Provider business mailing address

4845 ASHLEY PARK LN APT 137
CHARLOTTE NC
28210-4124
US

V. Phone/Fax

Practice location:
  • Phone: 843-523-5291
  • Fax:
Mailing address:
  • Phone: 954-806-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9439
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: