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General NPI Number Information
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NPI Number | 1902087984
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Entity Type | Organization
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Legal Business Name | HOLLIDAY DENTAL, PA
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 119 W ANTRIM DR
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City | GREENVILLE
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State | SC
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Zip | 29607-2505
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Country | US
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Telephone | 864-233-8639
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Fax | 864-233-9766
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Provider Business Mailing Address
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Address Line | 119 W ANTRIM DR
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City | GREENVILLE
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State | SC
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Zip | 29607-2505
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Country | US
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Telephone | 864-233-8639
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Fax | 864-233-9766
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Authorized Official
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Title or Position | SEC
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Name | MRS. JANICE HOLLIDAY
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Credential |
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Telephone | 864-233-8639
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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 | 2535
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License Number State | SC
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