Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 11062 | MA |
NPI | 1093729816 |
---|---|
Provider Name | Ralph P Pollack |
First Address | Dartmouth, MA 02747-3319 |
Second Address | Dartmouth, MA 02747-3319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |