Provider Demographics
NPI:1740344019
Name:HOLLAND, JOHN WILSON JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILSON
Last Name:HOLLAND
Suffix:JR
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 1:1310 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3316
Mailing Address - Country:US
Mailing Address - Phone:479-636-6807
Mailing Address - Fax:479-636-7337
Practice Address - Street 1:1310 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3316
Practice Address - Country:US
Practice Address - Phone:479-636-6807
Practice Address - Fax:479-636-7337
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR20201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice