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General NPI Number Information
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NPI Number | 1235393166
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Entity Type | Organization
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Legal Business Name | ABOVE BEYOND DENTISTRY AND IMPLANTS
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 1908 NW 1ST WAY SUITE 105
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City | BATTLE GROUND
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State | WA
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Zip | 98604
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Country | US
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Telephone | 360-687-0909
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Fax | 360-687-1502
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Provider Business Mailing Address
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Address Line | 1908 NW 1ST WAY STE 105
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City | BATTLE GROUND
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State | WA
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Zip | 98604-4560
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Country | US
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Telephone | 360-687-0909
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Fax | 360-687-1502
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MR. GLENN D HOLLAR
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Credential | DDS
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Telephone | 360-687-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4353
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License Number State | WA
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