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General NPI Number Information
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NPI Number | 1477964237
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Entity Type | Organization
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Legal Business Name | HOLLIDAY ORTHODONTICS, LLC
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Dates
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Enumeration Date | 05/15/2014
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 1245 KUALA ST SUITE 110
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City | PEARL CITY
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State | HI
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Zip | 96782-3900
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Country | US
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Telephone | 808-485-1177
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Fax | 808-485-1179
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Provider Business Mailing Address
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Address Line | 1245 KUALA ST SUITE 110
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City | PEARL CITY
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State | HI
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Zip | 96782-3900
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Country | US
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Telephone | 808-485-1177
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Fax | 808-485-1179
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Authorized Official
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Title or Position | MEMBER
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Name | DR. SEAN R HOLLIDAY
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Credential | DDS, MS
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Telephone | 808-485-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2077
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License Number State | HI
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