Glenn M Poch DDS LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12795 Issued in MD

Legal business name

GLENN M POCH DDS LLC

Practice address

2288 Blue Water Blvd
Suite 420
Odenton, MD 21113

Phone

(410) 674-3000

Fax

(410) 674-7000

NPI assigned

Sep 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glenn Michael Poch, DDS

Title

Managing Member

Phone

(410) 674-3000

Specialties & licenses 1

Addresses

Other names 1

• Blue Water Dental Care Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609978881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2288 BLUE WATER BLVD",
            "address_2": "SUITE 420",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "21113",
            "telephone_number": "410-674-3000",
            "fax_number": "410-674-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2288 BLUE WATER BLVD",
            "address_2": "SUITE 420",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "21113",
            "telephone_number": "410-674-3000",
            "fax_number": "410-674-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN M POCH DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POCH",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "410-674-3000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "12795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Water Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Odenton, MD
• Providers in Odenton, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.