MEDICARE: DR. JOSHUA DAVID POLLACK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9439	SC

General Provider Information

NPI Number	:	1033762323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA DAVID POLLACK DDS

Provider Business Mailing Address
First Line	:	4845 ASHLEY PARK LN APT 137
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-4124
Country	:	US
Telephone Number	:	954-806-8522
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 E TATUM AVE
Second Line	:
City	:	MC COLL
State	:	SC
Zip	:	29570-2323
Country	:	US
Telephone Number	:	843-523-5291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/17/2019

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