Healthcare Provider Details

I. General information

NPI: 1134208465
Provider Name (Legal Business Name): JEANETTE D SABIR-HOLLOWAY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 INDIANA AVE
INDIANAPOLIS IN
46202-3106
US

IV. Provider business mailing address

508 INDIANA AVE
INDIANAPOLIS IN
46202-3106
US

V. Phone/Fax

Practice location:
  • Phone: 317-269-0402
  • Fax: 317-269-0405
Mailing address:
  • Phone: 317-269-0402
  • Fax: 317-269-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12007938
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: