Provider Demographics
NPI:1942661905
Name:J. HOLLAR, DMD, PLLC
Entity Type:Organization
Organization Name:J. HOLLAR, DMD, PLLC
Other - Org Name:ORAL SURGERY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-450-2121
Mailing Address - Street 1:2621 NE 134TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3036
Mailing Address - Country:US
Mailing Address - Phone:360-450-2121
Mailing Address - Fax:360-859-4524
Practice Address - Street 1:2621 NE 134TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3036
Practice Address - Country:US
Practice Address - Phone:360-450-2121
Practice Address - Fax:360-859-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004353122300000X
WADE 000101611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2000538Medicaid