Provider Demographics
NPI:1427080092
Name:HOLLINGSWORTH, MICHAEL S (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:HOLLINGSWORTH
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 1:420 S WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3468
Mailing Address - Country:US
Mailing Address - Phone:816-232-8788
Mailing Address - Fax:816-232-2077
Practice Address - Street 1:420 S WOODBINE RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3468
Practice Address - Country:US
Practice Address - Phone:816-232-8788
Practice Address - Fax:816-232-2077
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO140331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice