Provider Demographics
NPI:1821355926
Name:HOLLIS, ALFRED W III
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:W
Last Name:HOLLIS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2532
Mailing Address - Country:US
Mailing Address - Phone:518-584-1400
Mailing Address - Fax:518-584-1028
Practice Address - Street 1:157 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2532
Practice Address - Country:US
Practice Address - Phone:518-584-1400
Practice Address - Fax:518-584-1028
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0487531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice