1013074020 NPI number — DR. VALERIE C POLLOCK DDS, PA

Table of content: DR. VALERIE C POLLOCK DDS, PA (NPI 1013074020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013074020 NPI number — DR. VALERIE C POLLOCK DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POLLOCK
Provider First Name:
VALERIE
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013074020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 874
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURGAW
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28425-0874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-259-2053
Provider Business Mailing Address Fax Number:
910-259-2057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 S BENNETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURGAW
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-259-2053
Provider Business Practice Location Address Fax Number:
910-259-2057
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X , with the licence number:  7419 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS1201X , with the licence number: 7419 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 7419 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 016FY . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1992881254 . This is a "GROUP NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 902E7 . This is a "BCBS OF NC MEDICAL BILLING" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89902E7 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1013074020 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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