Provider Demographics
NPI:1396182952
Name:FLACK, HOLLIE E PFEFFER (DDS)
Entity type:Individual
Prefix:DR
First Name:HOLLIE
Middle Name:E PFEFFER
Last Name:FLACK
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 1:6247 BROOKSIDE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-1645
Mailing Address - Country:US
Mailing Address - Phone:816-523-1444
Mailing Address - Fax:816-363-2899
Practice Address - Street 1:6247 BROOKSIDE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-1645
Practice Address - Country:US
Practice Address - Phone:816-523-1444
Practice Address - Fax:816-363-2899
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011016314122300000X, 1223G0001X
KS60960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist