Healthcare Provider Details

I. General information

NPI: 1699934380
Provider Name (Legal Business Name): HOLLY M MEISE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 HIGH ST W
PORTSMOUTH VA
23703-4505
US

IV. Provider business mailing address

1400 WATER MILL CIR
VIRGINIA BEACH VA
23454-1359
US

V. Phone/Fax

Practice location:
  • Phone: 757-638-8262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401413117
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: