Organization
JH DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB HOLLY DMD (DENTIST)
(623) 692-4774
Entity
Organization
Contact information
Practice address
42104 N VENTURE DR, ANTHEM, AZ 85086-3823
(623) 551-6300
Mailing address
9533 W BLUE SKY DR, PEORIA, AZ 85383-8741
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/27/2018
Last updated
06/27/2018
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