=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568686798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEAN R. HOLLIDAY D.D.S., M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98-1247 KAAHUMANU ST SUITE 202
-----------------------------------------------------
City | AIEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96701-5311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-485-1177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 98-1247 KAAHUMANU ST SUITE 202
-----------------------------------------------------
City | AIEA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96701-5311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-485-1177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 2077
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------