Provider Demographics
NPI:1740482744
Name:JOY HOLLINSHEAD DDS PC
Entity type:Organization
Organization Name:JOY HOLLINSHEAD DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLLINSHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-456-2182
Mailing Address - Street 1:109 3RD STREET WEST
Mailing Address - Street 2:BOX 119
Mailing Address - City:HALSTAD
Mailing Address - State:MN
Mailing Address - Zip Code:56548
Mailing Address - Country:US
Mailing Address - Phone:218-456-2182
Mailing Address - Fax:218-456-2382
Practice Address - Street 1:109 3RD STREET WEST
Practice Address - Street 2:
Practice Address - City:HALSTAD
Practice Address - State:MN
Practice Address - Zip Code:56548
Practice Address - Country:US
Practice Address - Phone:218-456-2182
Practice Address - Fax:218-456-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND111151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty