Provider Demographics
NPI:1184778268
Name:HOLLANDER, JAY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ALAN
Last Name:HOLLANDER
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 1:1255 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2203
Mailing Address - Country:US
Mailing Address - Phone:317-259-1501
Mailing Address - Fax:317-259-1543
Practice Address - Street 1:1255 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2203
Practice Address - Country:US
Practice Address - Phone:317-259-1501
Practice Address - Fax:317-259-1543
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007775A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice