Provider Demographics
NPI:1235522277
Name:HOLLAND DENTAL CARE PSC
Entity Type:Organization
Organization Name:HOLLAND DENTAL CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-534-4887
Mailing Address - Street 1:80 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-5633
Mailing Address - Country:US
Mailing Address - Phone:270-534-4887
Mailing Address - Fax:270-534-4859
Practice Address - Street 1:80 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-5633
Practice Address - Country:US
Practice Address - Phone:270-534-4887
Practice Address - Fax:270-534-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6765122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty