Provider Demographics
NPI:1952596058
Name:RICHARD D HOLLEY, DDS, PC
Entity Type:Organization
Organization Name:RICHARD D HOLLEY, DDS, PC
Other - Org Name:THE SMILE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-473-3111
Mailing Address - Street 1:20950 N TATUM BLVD
Mailing Address - Street 2:#350
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4200
Mailing Address - Country:US
Mailing Address - Phone:480-473-3111
Mailing Address - Fax:480-473-3114
Practice Address - Street 1:20950 N TATUM BLVD
Practice Address - Street 2:#350
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4200
Practice Address - Country:US
Practice Address - Phone:480-473-3111
Practice Address - Fax:480-473-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4573261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental