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General NPI Number Information
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NPI Number | 1780896274
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Entity Type | Organization
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Legal Business Name | KENNETH E. HOLLAND, JR., DDS, MS, PC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 8841 EAST FLORENTINE ROAD SUITE D
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314
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Country | US
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Telephone | 928-759-9200
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Fax | 928-775-0248
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Provider Business Mailing Address
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Address Line | 8841 EAST FLORENTINE ROAD SUITE D
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314
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Country | US
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Telephone | 928-759-9200
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Fax | 928-775-0248
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Authorized Official
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Title or Position | PRESICENT
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Name | DR. KENNETH EUGENE HOLLAND JR.
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Credential | DDS, MS
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Telephone | 928-759-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4291
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License Number State | AZ
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