Provider Demographics
NPI:1093935256
Name:HOLLAND, TAYLOR H III (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:H
Last Name:HOLLAND
Suffix:III
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 1:518 S. SPRING AVE.
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704
Mailing Address - Country:US
Mailing Address - Phone:903-592-0741
Mailing Address - Fax:
Practice Address - Street 1:518 S SPRING AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8140
Practice Address - Country:US
Practice Address - Phone:903-592-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX751308513OtherTAXPAYER IDENTIFICATION