Provider Demographics
NPI:1063678431
Name:HOLLINGSWORTH, JAMES W (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-9597
Mailing Address - Country:US
Mailing Address - Phone:601-683-7878
Mailing Address - Fax:601-683-7272
Practice Address - Street 1:215 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-9597
Practice Address - Country:US
Practice Address - Phone:601-683-7878
Practice Address - Fax:601-683-7272
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2732-93122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660044Medicaid