Active NPI
Bernard Matt Hollis, D.D.S.
- General Practice Dentistry
- Bossier City, LA
National Provider Identifier
1669766937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6147
- Practice address
- 4530 Benton Rd Ste 200
Bossier City, LA 71111-2435 - Phone
- (318) 375-2851
- NPI assigned
- Jun 4, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6147 | LA | Primary |
Addresses
Primary practice location
4530 Benton Rd Ste 200
Bossier City, LA 71111-2435
Mailing address
117 N Pine St
Vivian, LA 71082-2743
Phone (318) 375-2851
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6147 | LA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1669766937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 N PINE ST",
"city": "VIVIAN",
"state": "LA",
"postal_code": "710822743",
"telephone_number": "318-375-2851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4530 BENTON RD STE 200",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "711112435",
"telephone_number": "318-375-2851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLLIS",
"first_name": "BERNARD",
"middle_name": "MATT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-04",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "6147",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bossier City, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.