Provider Demographics
NPI:1578692349
Name:HOLLAR, GAIL ANN (DDS)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ANN
Last Name:HOLLAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WESTERN CENTER BLVD.
Mailing Address - Street 2:#128
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131
Mailing Address - Country:US
Mailing Address - Phone:817-847-1131
Mailing Address - Fax:817-847-1168
Practice Address - Street 1:2700 WESTERN CENTER BLVD.
Practice Address - Street 2:#128
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131
Practice Address - Country:US
Practice Address - Phone:817-847-1131
Practice Address - Fax:817-847-1168
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice