MEDICARE: DANA J HOLLENBECK 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	122300000X	Dentist	2901020978	MI

General Provider Information

NPI Number	:	1891133971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA J HOLLENBECK D.D.S.

Provider Business Mailing Address
First Line	:	271 SKYLINE DR
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8622
Country	:	US
Telephone Number	:	260-615-6720
Fax Number	:

Provider Business Practice Location Address
First Line	:	2692 S STRAITS HWY
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-9792
Country	:	US
Telephone Number	:	231-238-9346
Fax Number	:

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

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	08/29/2023

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