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General NPI Number Information
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NPI Number | 1497443980
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Entity Type | Individual
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Provider Name | KYLIE LARUE HOLLIDAY
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Gender | Female
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 8222 BRUTON RD
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City | DALLAS
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State | TX
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Zip | 75217-1902
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Country | US
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Telephone | 214-398-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 CITYPLACE WEST BLVD APT 437
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City | DALLAS
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State | TX
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Zip | 75204-0360
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Country | US
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Telephone | 928-713-4198
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 39765
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License Number State | TX
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