Healthcare Provider Details

I. General information

NPI: 1497958250
Provider Name (Legal Business Name): MICHAEL S. HOLLINGSWORTH, DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S WOODBINE RD
SAINT JOSEPH MO
64506-3468
US

IV. Provider business mailing address

420 S WOODBINE RD
SAINT JOSEPH MO
64506-3468
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-8788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14033
License Number StateMO

VIII. Authorized Official

Name: DR. MICHAEL S HOLLINGSWORTH
Title or Position: DENTIST
Credential: DDS
Phone: 816-232-8788