Provider Demographics
NPI:1447671805
Name:HOLLIS, KELLY MICHELE (DDS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELE
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 DOGWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315
Mailing Address - Country:US
Mailing Address - Phone:717-845-9664
Mailing Address - Fax:717-845-9666
Practice Address - Street 1:2320 DOGWOOD ROAD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315
Practice Address - Country:US
Practice Address - Phone:717-845-9664
Practice Address - Fax:717-845-9666
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030780L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice