Provider Demographics
NPI:1710424049
Name:HOLLAND FAMILY DENTISTRY, SCOTTSBORO, LLC
Entity Type:Organization
Organization Name:HOLLAND FAMILY DENTISTRY, SCOTTSBORO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMM
Authorized Official - Phone:256-574-5121
Mailing Address - Street 1:416 PARKS AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2440
Mailing Address - Country:US
Mailing Address - Phone:256-574-5121
Mailing Address - Fax:256-574-5123
Practice Address - Street 1:416 PARKS AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2440
Practice Address - Country:US
Practice Address - Phone:256-574-5121
Practice Address - Fax:256-574-5123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty