Provider Demographics
NPI:1033233432
Name:HOLLENBERG, RANDALL W (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:W
Last Name:HOLLENBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S MASON RD
Mailing Address - Street 2:STE B-2
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3896
Mailing Address - Country:US
Mailing Address - Phone:281-392-3333
Mailing Address - Fax:281-392-4083
Practice Address - Street 1:830 S MASON RD
Practice Address - Street 2:STE B-2
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3896
Practice Address - Country:US
Practice Address - Phone:281-392-3333
Practice Address - Fax:281-392-4083
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry