Provider Demographics
NPI:1679063820
Name:R. BRIAN HOLLINGSWORTH, DMD, LLC
Entity Type:Organization
Organization Name:R. BRIAN HOLLINGSWORTH, DMD, LLC
Other - Org Name:HOLLINGSWORTH FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-512-0343
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-0307
Mailing Address - Country:US
Mailing Address - Phone:205-512-0343
Mailing Address - Fax:205-512-0364
Practice Address - Street 1:170 APACHE ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5400
Practice Address - Country:US
Practice Address - Phone:205-512-0343
Practice Address - Fax:205-512-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5164261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center