Healthcare Provider Details

I. General information

NPI: 1780896274
Provider Name (Legal Business Name): KENNETH E. HOLLAND, JR., DDS, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8841 EAST FLORENTINE ROAD SUITE D
PRESCOTT VALLEY AZ
86314
US

IV. Provider business mailing address

8841 EAST FLORENTINE ROAD SUITE D
PRESCOTT VALLEY AZ
86314
US

V. Phone/Fax

Practice location:
  • Phone: 928-759-9200
  • Fax: 928-775-0248
Mailing address:
  • Phone: 928-759-9200
  • Fax: 928-775-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4291
License Number StateAZ

VIII. Authorized Official

Name: DR. KENNETH EUGENE HOLLAND JR.
Title or Position: PRESICENT
Credential: DDS, MS
Phone: 928-759-9200