MEDICARE: JAY A. HOLLANDER, D.D.S., P.C.

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	1223G0001X	General Practice Dentistry	12007775A	IN

General Provider Information

NPI Number	:	1649325507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY A. HOLLANDER, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	1255 W 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2203
Country	:	US
Telephone Number	:	317-259-1501
Fax Number	:	317-259-1543

Provider Business Practice Location Address
First Line	:	1255 W 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2203
Country	:	US
Telephone Number	:	317-259-1501
Fax Number	:	317-259-1543

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAY ALAN HOLLANDER
Credential	:	D.D.S.
Telephone Number	:	317-259-1501

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/22/2020

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