Provider Demographics
NPI:1396922803
Name:G. KEVIN POLLOCK DDS, MS, PA
Entity type:Organization
Organization Name:G. KEVIN POLLOCK DDS, MS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:469-698-9800
Mailing Address - Street 1:960 WEST RALPH HALL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6660
Mailing Address - Country:US
Mailing Address - Phone:469-698-9800
Mailing Address - Fax:469-698-9804
Practice Address - Street 1:960 WEST RALPH HALL PARKWAY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6660
Practice Address - Country:US
Practice Address - Phone:469-698-9800
Practice Address - Fax:469-698-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty