Provider Demographics
NPI:1891808580
Name:DANE L. HOLLIS,D.D.S.,P.C.
Entity Type:Organization
Organization Name:DANE L. HOLLIS,D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-925-3632
Mailing Address - Street 1:14533 E HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-8087
Mailing Address - Country:US
Mailing Address - Phone:479-925-3632
Mailing Address - Fax:
Practice Address - Street 1:14533 E HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-8087
Practice Address - Country:US
Practice Address - Phone:479-925-3632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3060261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental