Provider Demographics
NPI:1588495840
Name:HOLLON, SHANE (DMD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:
Last Name:HOLLON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N STANTON ST UNIT 23
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1237
Mailing Address - Country:US
Mailing Address - Phone:903-456-1694
Mailing Address - Fax:
Practice Address - Street 1:4800 N STANTON ST UNIT 23
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1237
Practice Address - Country:US
Practice Address - Phone:903-456-1694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40907390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program