Provider Demographics
NPI:1326001645
Name:HOLLIS, BRYAN J (DDS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:J
Last Name:HOLLIS
Suffix:
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 1:16270 AIRLINE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4248
Mailing Address - Country:US
Mailing Address - Phone:225-744-2722
Mailing Address - Fax:225-744-2724
Practice Address - Street 1:16270 AIRLINE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4248
Practice Address - Country:US
Practice Address - Phone:225-744-2722
Practice Address - Fax:225-744-2724
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics