Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 13188 | TX |
NPI | 1033233432 |
---|---|
Provider Name | Dr. Randall W Hollenberg |
First Address | Katy, TX 77450-3896 |
Second Address | Katy, TX 77450-3896 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |