Healthcare Provider Details

I. General information

NPI: 1437703964
Provider Name (Legal Business Name): HOLLY HILL DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BUNCH FORD RD
HOLLY HILL SC
29059-8401
US

IV. Provider business mailing address

102 BRYANT ST
SAINT GEORGE SC
29477-2160
US

V. Phone/Fax

Practice location:
  • Phone: 803-496-9012
  • Fax: 803-496-7054
Mailing address:
  • Phone: 843-563-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY TAYLOR JOHNSTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-563-3208