# DR. SAM R POLLOCK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1376638304
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2051 | MT | — |
| 1223G0001X | General Practice Dentistry | 2051 | MT | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 11/01/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0120105 | — | MT |
| 01 | — | 20514 | BLUECROSS | MT |
| 01 | — | 5512369 | CHIP | MT |