Provider Demographics
NPI:1013982016
Name:HOLLAND, PETER L (D D S)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N ELM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3026
Mailing Address - Country:US
Mailing Address - Phone:940-387-7717
Mailing Address - Fax:940-387-1628
Practice Address - Street 1:1601 N ELM ST
Practice Address - Street 2:SUITE A
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3026
Practice Address - Country:US
Practice Address - Phone:940-387-7717
Practice Address - Fax:940-387-1628
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD137561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT13877Medicare UPIN