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General NPI Number Information
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NPI Number | 1598047888
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Entity Type | Individual
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Provider Name | CYNTHIA RENEE HOLLIDAY D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 2005 KNIGHT LANE BLDG H NAVY MEDICINE SUPPORT ATTN: MEDICAL STAFF SERVICES
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City | JACKSONVILLE
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State | FL
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Zip | 32212-0140
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Country | US
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Telephone | 559-334-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 790 CAMINO DE LA REINA APT 176
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City | SAN DIEGO
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State | CA
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Zip | 92108-3273
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Country | US
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Telephone | 559-334-7788
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 60756
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License Number State | CA
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