Provider Demographics
NPI:1023121712
Name:HOLLIS, DANE L (DDS)
Entity type:Individual
Prefix:DR
First Name:DANE
Middle Name:L
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice