Healthcare Provider Details

I. General information

NPI: 1093500662
Provider Name (Legal Business Name): KEVIN LEE HOLLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 BATTLEGROUND AVE
GREENSBORO NC
27408-5422
US

IV. Provider business mailing address

600 JUDGES RD
BURNET TX
78611-2047
US

V. Phone/Fax

Practice location:
  • Phone: 133-635-5455
  • Fax:
Mailing address:
  • Phone: 512-750-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41861
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: