Healthcare Provider Details

I. General information

NPI: 1639512254
Provider Name (Legal Business Name): SETH ADAM HOLLAND DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 06/13/2024
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S GARDEN WAY STE 190
EUGENE OR
97401-8184
US

IV. Provider business mailing address

330 S GARDEN WAY # 190A
EUGENE OR
97401-8176
US

V. Phone/Fax

Practice location:
  • Phone: 541-747-0101
  • Fax: 541-747-6494
Mailing address:
  • Phone: 541-686-4953
  • Fax: 541-747-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD10019
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10019
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberTD-00-58
License Number StateNM

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: