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General NPI Number Information
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NPI Number | 1952312209
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Entity Type | Organization
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Legal Business Name | JERROLD J. POLLACK,D.D.S.,P.A
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1133 KESWICK PL
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City | FREDERICK
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State | MD
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Zip | 21703-6168
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Country | US
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Telephone | 301-694-9655
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Fax |
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Provider Business Mailing Address
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Address Line | 5405 WOODLYN CT
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City | FREDERICK
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State | MD
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Zip | 21703-6963
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Country | US
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Telephone | 301-371-7730
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Fax |
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Authorized Official
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Title or Position | PRESIDENT-OWNER
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Name | DR. JERROLD JEROME POLLACK
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Credential | D.D.S.
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Telephone | 301-694-9655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3810
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License Number State | MD
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