Provider Demographics
NPI:1861569634
Name:WOLCOTT, HOLLIS WHITNEY JR (DDS)
Entity type:Individual
Prefix:
First Name:HOLLIS
Middle Name:WHITNEY
Last Name:WOLCOTT
Suffix:JR
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 1:523 DAINGERFIELD STREET
Mailing Address - Street 2:PO BOX 1741
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560
Mailing Address - Country:US
Mailing Address - Phone:804-443-6642
Mailing Address - Fax:804-443-6642
Practice Address - Street 1:523 DAINGERFIELD STREET
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560
Practice Address - Country:US
Practice Address - Phone:804-443-6642
Practice Address - Fax:804-443-6642
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice