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General NPI Number Information
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NPI Number | 1710424049
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Entity Type | Organization
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Legal Business Name | HOLLAND FAMILY DENTISTRY, SCOTTSBORO, LLC
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 416 PARKS AVE
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City | SCOTTSBORO
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State | AL
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Zip | 35768-2440
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Country | US
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Telephone | 256-574-5121
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Fax | 256-574-5123
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Provider Business Mailing Address
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Address Line | 416 PARKS AVE
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City | SCOTTSBORO
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State | AL
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Zip | 35768-2440
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Country | US
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Telephone | 256-574-5121
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Fax | 256-574-5123
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Authorized Official
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Title or Position | DENTIST
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Name | ALEX HOLLAND
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Credential | D.M.M
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Telephone | 256-574-5121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5465
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License Number State | AL
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