Individual ProviderJonathan D HollandDentistDental ProvidersPractice Address3600 N Buffalo Dr, Suite 100, Las Vegas, NV 89129-7444(702) 405-6100PECOS EnrollmentBased on the most recent information from CMS, provider Jonathan D Holland does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1770650327Provider TypeIndividualFull NameHolland, Jonathan DTitleDr.CredentialDDSGenderMaleSole ProprietorYesEnumeration Date11/29/2006Last Updated6/23/2008Contact InformationPractice LocationPractice Address3600 N Buffalo Dr, Suite 100, Las Vegas, NV 89129-7444Phone(702) 405-6100Fax(702) 405-6101Mailing LocationMailing Address3600 N Buffalo Dr, Suite 100, Las Vegas, NV 89129-7444Phone(702) 405-6100Fax(702) 405-6101Provider TaxonomiesCodeDescriptionLicenseCode122300000XPrimaryDescriptionDentistDental ProvidersLicense4919NevadaProvider IdentifiersIDDescriptionIssuerID100509704DescriptionMedicaidIssuerUnlistedNevada