Healthcare Provider Details

I. General information

NPI: 1891808580
Provider Name (Legal Business Name): DANE L. HOLLIS,D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14533 E HIGHWAY 12
ROGERS AR
72756-8087
US

IV. Provider business mailing address

14533 E HIGHWAY 12
ROGERS AR
72756-8087
US

V. Phone/Fax

Practice location:
  • Phone: 479-925-3632
  • Fax:
Mailing address:
  • Phone: 479-925-3632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3060
License Number StateAR

VIII. Authorized Official

Name: DR. DANE L HOLLIS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 479-925-3632