Provider Demographics
NPI:1992881254
Name:VALERIE C. POLLOCK, D.D.S., P.A.
Entity type:Organization
Organization Name:VALERIE C. POLLOCK, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-259-2053
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-0874
Mailing Address - Country:US
Mailing Address - Phone:910-259-2053
Mailing Address - Fax:910-259-2057
Practice Address - Street 1:302 S BENNETT ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-0874
Practice Address - Country:US
Practice Address - Phone:910-259-2053
Practice Address - Fax:910-259-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74191223G0001X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902E7Medicaid
NC016FYOtherBCBS OF NORTH CAROLINA #
NC1642657OtherUNITED CONCORDIA PROVIDER