Healthcare Provider Details

I. General information

NPI: 1962328724
Provider Name (Legal Business Name): HOLLIS PEI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 ADMIRAL TAUSSIG BLVD
NORFOLK VA
23511-2803
US

IV. Provider business mailing address

5243 SERENO DR UNIT A
TEMPLE CITY CA
91780-3014
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-8635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420128
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: