Individual
JACOB HOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3750 W GREENWAY RD, PHOENIX, AZ 85053-3703
(623) 377-4945
Mailing address
9533 W BLUE SKY DR, PEORIA, AZ 85383-8741
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D009739
AZ
Other
Enumeration date
06/05/2017
Last updated
06/05/2017
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