Provider Demographics
NPI:1104030758
Name:HOLLANDER, BRIAN ALLAN
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALLAN
Last Name:HOLLANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7432 SW MILES PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3087
Mailing Address - Country:US
Mailing Address - Phone:503-452-0680
Mailing Address - Fax:
Practice Address - Street 1:7432 SW MILES PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-3087
Practice Address - Country:US
Practice Address - Phone:503-452-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD5053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist