MEDICARE: GAIL ANN HOLLAR D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	15328	TX

General Provider Information

NPI Number	:	1578692349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL ANN HOLLAR D.D.S.

Provider Business Mailing Address
First Line	:	2700 WESTERN CENTER BLVD.
Second Line	:	#128
City	:	FORT WORTH
State	:	TX
Zip	:	76131
Country	:	US
Telephone Number	:	817-847-1131
Fax Number	:	817-847-1168

Provider Business Practice Location Address
First Line	:	2700 WESTERN CENTER BLVD.
Second Line	:	#128
City	:	FORT WORTH
State	:	TX
Zip	:	76131
Country	:	US
Telephone Number	:	817-847-1131
Fax Number	:	817-847-1168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	08/12/2010

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Directions to “ GAIL ANN HOLLAR D.D.S.” Practice Location

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