Provider Demographics
NPI:1487740916
Name:HOLLIS, CRAIG R (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:R
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5043 E BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1301
Mailing Address - Country:US
Mailing Address - Phone:480-654-5500
Mailing Address - Fax:480-282-4799
Practice Address - Street 1:5043 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1301
Practice Address - Country:US
Practice Address - Phone:480-654-5500
Practice Address - Fax:480-282-4799
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice