Provider Demographics
NPI:1760612188
Name:HOLLIS, DANNY V
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:V
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DANNY
Other - Middle Name:V
Other - Last Name:HOLLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LD
Mailing Address - Street 1:33 GRANITE ROCK CIR N
Mailing Address - Street 2:
Mailing Address - City:SURRY
Mailing Address - State:ME
Mailing Address - Zip Code:04684-3601
Mailing Address - Country:US
Mailing Address - Phone:207-664-7444
Mailing Address - Fax:207-664-7444
Practice Address - Street 1:33 GRANITE ROCK CIR N
Practice Address - Street 2:
Practice Address - City:SURRY
Practice Address - State:ME
Practice Address - Zip Code:04684-3601
Practice Address - Country:US
Practice Address - Phone:207-664-7444
Practice Address - Fax:207-664-7444
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5018122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME235280000OtherMAINECARE