Provider Demographics
NPI:1235393166
Name:ABOVE BEYOND DENTISTRY AND IMPLANTS
Entity Type:Organization
Organization Name:ABOVE BEYOND DENTISTRY AND IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-687-0909
Mailing Address - Street 1:1908 NW 1ST WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4560
Mailing Address - Country:US
Mailing Address - Phone:360-687-0909
Mailing Address - Fax:360-687-1502
Practice Address - Street 1:1908 NW 1ST WAY SUITE 105
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604
Practice Address - Country:US
Practice Address - Phone:360-687-0909
Practice Address - Fax:360-687-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA43531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty