MEDICARE: GEORGE W. HOLLING DDS, MS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	8614	CO

General Provider Information

NPI Number	:	1063890440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE W. HOLLING DDS, MS, PC

Provider Business Mailing Address
First Line	:	1625 FOXTRAIL DR
Second Line	:	SUITE 100
City	:	LOVELAND
State	:	CO
Zip	:	80538-9088
Country	:	US
Telephone Number	:	970-669-7300
Fax Number	:	970-669-7301

Provider Business Practice Location Address
First Line	:	1625 FOXTRAIL DR
Second Line	:	SUITE 100
City	:	LOVELAND
State	:	CO
Zip	:	80538-9088
Country	:	US
Telephone Number	:	970-669-7300
Fax Number	:	970-669-7301

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	LISA COLLETTE HOLLING
Credential	:
Telephone Number	:	970-669-7300

Provider Enumeration Date	:	05/18/2015
Last Update Date	:	05/18/2015

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