Provider Demographics
NPI:1912925504
Name:HOLLINGSWORTH, CRAIG BRUCE (DDS PEDODONTIST)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:BRUCE
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:DDS PEDODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 21ST ST
Mailing Address - Street 2:#7
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818
Mailing Address - Country:US
Mailing Address - Phone:916-452-5231
Mailing Address - Fax:916-452-5294
Practice Address - Street 1:2650 21ST ST
Practice Address - Street 2:#7
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818
Practice Address - Country:US
Practice Address - Phone:916-452-5231
Practice Address - Fax:916-452-5294
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA244601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry