Provider Demographics
NPI:1578631180
Name:HOLLIS, MARY ANN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:MARIE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OAK BROOK CLUB
Mailing Address - Street 2:#F308
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-530-4122
Mailing Address - Fax:630-530-4122
Practice Address - Street 1:2 E 22ND STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-627-4680
Practice Address - Fax:630-627-4690
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist