Provider Demographics
NPI:1730293465
Name:HOLLYFIELD, NEIL DAVIS (DDS)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:DAVIS
Last Name:HOLLYFIELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354
Mailing Address - Country:US
Mailing Address - Phone:276-783-8131
Mailing Address - Fax:276-783-1839
Practice Address - Street 1:645 PARK BLVD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354
Practice Address - Country:US
Practice Address - Phone:276-783-8131
Practice Address - Fax:276-783-1839
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005753122300000X
VA04380001651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178619Medicaid
VA190000007Medicare PIN
VA9178619Medicaid