Provider Demographics
NPI:1518971431
Name:HOLLINGSWORTH DENTAL CLINIC, P.A.
Entity Type:Organization
Organization Name:HOLLINGSWORTH DENTAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-683-7878
Mailing Address - Street 1:215 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MS
Mailing Address - Zip Code:39345-9597
Mailing Address - Country:US
Mailing Address - Phone:601-683-7878
Mailing Address - Fax:601-683-7272
Practice Address - Street 1:215 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-9597
Practice Address - Country:US
Practice Address - Phone:601-683-7878
Practice Address - Fax:601-683-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660044Medicaid