Healthcare Provider Details

I. General information

NPI: 1215224738
Provider Name (Legal Business Name): GABRIEL MARTIN HOLLEY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 08/29/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110A HOSPITAL DR
SIMPSONVILLE SC
29681-3226
US

IV. Provider business mailing address

110A HOSPITAL DR
SIMPSONVILLE SC
29681-3226
US

V. Phone/Fax

Practice location:
  • Phone: 304-377-0014
  • Fax:
Mailing address:
  • Phone: 864-987-7030
  • Fax: 864-987-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8212
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number817
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8212
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: