Provider Demographics
NPI:1861698193
Name:HOLLAR, JUSTIN MICAH (DMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MICAH
Last Name:HOLLAR
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 1:2126 AHAPII PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1016
Mailing Address - Country:US
Mailing Address - Phone:773-315-5839
Mailing Address - Fax:
Practice Address - Street 1:1060 YOUNG ST
Practice Address - Street 2:SUITE 312
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1609
Practice Address - Country:US
Practice Address - Phone:808-585-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190261001223S0112X
WADE000101611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery