Healthcare Provider Details

I. General information

NPI: 1326720517
Provider Name (Legal Business Name): KENDRA HOLLIGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W MICHIGAN ST
INDIANAPOLIS IN
46202-5186
US

IV. Provider business mailing address

620 S BROWN ST
WINCHESTER IN
47394-2102
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-7433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12014476A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: