Active NPI
Sam R Pollock, DDS
- General Practice Dentistry
- Laurel, MT
National Provider Identifier
1376638304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2051
- Practice address
- 15 Montana Ave
Laurel, MT 59044 - Phone
- (406) 628-6716
- Fax
- (406) 628-6373
- NPI assigned
- Oct 4, 2006
- Last updated
- Nov 1, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2051 | MT | |
| General Practice Dentistry | 1223G0001X | 2051 | MT | Primary |
Addresses
Primary practice location
15 Montana Ave
Laurel, MT 59044
Mailing address
PO Box 1025
Laurel, MT 59044
Phone (406) 628-6716
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0120105 | Medicaid | MT | |
| 20514 | Other | MT | BLUECROSS |
| 5512369 | Other | MT | CHIP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150310002429 | MT | Order and Referring Only - Oral Surgery | 9830415827 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2051 | MT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509494400000",
"number": "1376638304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1025",
"city": "LAUREL",
"state": "MT",
"postal_code": "59044",
"telephone_number": "406-628-6716",
"fax_number": "406-628-6373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 MONTANA AVE",
"city": "LAUREL",
"state": "MT",
"postal_code": "59044",
"telephone_number": "406-628-6716",
"fax_number": "406-628-6373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLOCK",
"first_name": "SAM",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2017-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MT",
"license": "2051",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MT",
"license": "2051",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0120105",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS",
"identifier": "20514",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHIP",
"identifier": "5512369",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Laurel, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.