Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 5018 | ME |
NPI | 1760612188 |
---|---|
Provider Name | Danny V Hollis |
First Address | Surry, ME 04684-3601 |
Second Address | Surry, ME 04684-3601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2009 |
Last Update Date | 20/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
235280000 | MAINECARE (01) | ME |