Provider Demographics
NPI:1427061464
Name:POLLOCK, PEGGY A (RDH)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:A
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2222 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3709
Mailing Address - Country:US
Mailing Address - Phone:715-394-5411
Mailing Address - Fax:715-392-5086
Practice Address - Street 1:2222 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3709
Practice Address - Country:US
Practice Address - Phone:715-394-5411
Practice Address - Fax:715-392-5086
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5732124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5732OtherLICENSE