Healthcare Provider Details

I. General information

NPI: 1790190304
Provider Name (Legal Business Name): HOLLY HALDEMAN-COLLINS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N PIKE ST
GRAFTON WV
26354-1221
US

IV. Provider business mailing address

25 W BLUEMONT ST
GRAFTON WV
26354-1242
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-4600
  • Fax: 304-265-6008
Mailing address:
  • Phone: 304-265-0312
  • Fax: 304-265-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4107
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: