Individual
DR. JACK HOLLINGSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3223 N BROAD ST, PHILADELPHIA, PA 19140-5007
(215) 707-2880
Mailing address
505 S 10TH ST, UNIT J, PHILADELPHIA, PA 19147-1252
(215) 629-9755
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS016011L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DS016011L
PA DENTIST LICENSE
PA
Enumeration date
11/15/2016
Last updated
11/15/2016
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