MEDICARE: GEORGE ERNEST HOLLAND JR. DMD

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	122300000X	Dentist	SC1691	SC

General Provider Information

NPI Number	:	1760491740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE ERNEST HOLLAND JR. DMD

Provider Business Mailing Address
First Line	:	6941 NORTH TRENHOLM RD
Second Line	:	SUITE N2
City	:	COLUMBIA
State	:	SC
Zip	:	29206-1715
Country	:	US
Telephone Number	:	803-782-5492
Fax Number	:

Provider Business Practice Location Address
First Line	:	6941 NORTH TRENHOLM RD
Second Line	:	SUITE N2
City	:	COLUMBIA
State	:	SC
Zip	:	29206-1715
Country	:	US
Telephone Number	:	803-782-5492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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