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General NPI Number Information
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NPI Number | 1942661905
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Entity Type | Organization
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Legal Business Name | J. HOLLAR, DMD, PLLC
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 2621 NE 134TH ST SUITE 210
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City | VANCOUVER
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State | WA
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Zip | 98686-3036
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Country | US
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Telephone | 360-450-2121
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Fax | 360-859-4524
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Provider Business Mailing Address
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Address Line | 2621 NE 134TH ST SUITE 210
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City | VANCOUVER
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State | WA
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Zip | 98686-3036
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Country | US
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Telephone | 360-450-2121
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Fax | 360-859-4524
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Authorized Official
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Title or Position | OWNER/ORAL SURGEON
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Name | JUSTIN M HOLLAR
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Credential | DMD
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Telephone | 360-450-2121
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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 | DE00004353
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE 00010161
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License Number State | WA
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