Healthcare Provider Details

I. General information

NPI: 1235522277
Provider Name (Legal Business Name): HOLLAND DENTAL CARE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LAKEVIEW DR
PADUCAH KY
42001-5633
US

IV. Provider business mailing address

80 LAKEVIEW DR
PADUCAH KY
42001-5633
US

V. Phone/Fax

Practice location:
  • Phone: 270-534-4887
  • Fax: 270-534-4859
Mailing address:
  • Phone: 270-534-4887
  • Fax: 270-534-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6765
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY LYNN HOLLAND
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 270-534-4887