Healthcare Provider Details

I. General information

NPI: 1740515949
Provider Name (Legal Business Name): NAEEMAH HOLLY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6139 WILSON MILLS RD
HIGHLAND HTS OH
44143-2101
US

IV. Provider business mailing address

6139 WILSON MILLS RD
HIGHLAND HTS OH
44143-2101
US

V. Phone/Fax

Practice location:
  • Phone: 216-342-2600
  • Fax: 216-342-2602
Mailing address:
  • Phone: 216-342-2600
  • Fax: 216-342-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS038067
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30.023142
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: