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NPI Code Detail

MEDICARE: DR. SIDNEY ANTHONY HOLLEMAN JR. DDS

MEDICARE: DR. SIDNEY ANTHONY HOLLEMAN JR. DDS
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
11223G0001XGeneral Practice Dentistry8786TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M473OTHERTXBCBS ID #

General Provider Information

NPI Number : 1972517126
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SIDNEY ANTHONY HOLLEMAN JR. DDS
Provider Business Mailing Address
First Line : 1116 S HENDERSON ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4430
Country : US
Telephone Number : 817-336-6048
Fax Number : 817-334-0621
Provider Business Practice Location Address
First Line : 1116 S HENDERSON ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4430
Country : US
Telephone Number : 817-336-6048
Fax Number : 817-334-0621
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/15/2010

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