Healthcare Provider Details

I. General information

NPI: 1588732895
Provider Name (Legal Business Name): ROBERT D HOLLAND JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 FOREST DR
COLUMBIA SC
29204-4313
US

IV. Provider business mailing address

4019 FOREST DR
COLUMBIA SC
29204-4313
US

V. Phone/Fax

Practice location:
  • Phone: 803-787-5445
  • Fax: 803-787-5416
Mailing address:
  • Phone: 803-787-5445
  • Fax: 803-787-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2991
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: