Provider Demographics
NPI:1740376680
Name:HOLLAND, CHARLES WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WAYNE
Last Name:HOLLAND
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 1:1310 NASH STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-237-3117
Mailing Address - Fax:
Practice Address - Street 1:1310 NASH STREET NORTH
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-237-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC94025OtherBLUE CROSS BLUE SHD
NC3934OtherDELTA DENTAL
NC8994025Medicaid
U35476Medicare UPIN