Provider Demographics
NPI:1437223674
Name:HOLLEN, JOANN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:E
Last Name:HOLLEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:240 BLOSSOM PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9079
Mailing Address - Country:US
Mailing Address - Phone:502-570-8841
Mailing Address - Fax:502-570-8891
Practice Address - Street 1:240 BLOSSOM PARK DR
Practice Address - Street 2:SUITE 2
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9079
Practice Address - Country:US
Practice Address - Phone:502-570-8841
Practice Address - Fax:502-570-8891
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60002748Medicaid