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General NPI Number Information
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NPI Number | 1962609529
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Entity Type | Organization
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Legal Business Name | LEE F. HOLLISTER,DDS JON E. HOLLISTERDDS DENTAL CORPORATION
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1042 PACIFIC ST SUITE B
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3621
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Country | US
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Telephone | 805-543-6963
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Fax | 805-543-8656
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Provider Business Mailing Address
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Address Line | 1042 PACIFIC ST SUITE B
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3621
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Country | US
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Telephone | 805-543-6963
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Fax | 805-543-8656
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | JON E. HOLLISTER
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Credential | DDS
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Telephone | 805-543-6963
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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 | 28328
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License Number State | CA
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