Provider Demographics
NPI:1740840362
Name:HOLLINGER, NOAH CALEB (BA, DDS)
Entity type:Individual
Prefix:DR
First Name:NOAH
Middle Name:CALEB
Last Name:HOLLINGER
Suffix:
Gender:M
Credentials:BA, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7875
Mailing Address - Country:US
Mailing Address - Phone:208-449-0215
Mailing Address - Fax:
Practice Address - Street 1:1100 E POLSTON AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7875
Practice Address - Country:US
Practice Address - Phone:208-777-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-50511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice