Provider Demographics
NPI:1881953875
Name:DR. JOHN HOLLINGSWORTH, DDS
Entity type:Organization
Organization Name:DR. JOHN HOLLINGSWORTH, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTISTRY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:316-682-7522
Mailing Address - Street 1:2814 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4707
Mailing Address - Country:US
Mailing Address - Phone:316-682-7522
Mailing Address - Fax:316-682-3392
Practice Address - Street 1:2814 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4707
Practice Address - Country:US
Practice Address - Phone:316-682-7522
Practice Address - Fax:316-682-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS=========OtherGENERAL DENTISTRY