Healthcare Provider Details

I. General information

NPI: 1649596248
Provider Name (Legal Business Name): DENNIS JON HOLLY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW ARIZONA AVE STE 100
BEND OR
97703-3298
US

IV. Provider business mailing address

701 NW ARIZONA AVE STE 100
BEND OR
97703-3298
US

V. Phone/Fax

Practice location:
  • Phone: 541-317-5732
  • Fax:
Mailing address:
  • Phone: 541-317-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD8793
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: