Provider Demographics
NPI:1710012893
Name:HOLLAND, JEFFREY LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LYNN
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-5633
Mailing Address - Country:US
Mailing Address - Phone:270-534-4887
Mailing Address - Fax:270-534-4859
Practice Address - Street 1:80 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-5633
Practice Address - Country:US
Practice Address - Phone:270-534-4887
Practice Address - Fax:270-534-4859
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice