MEDICARE: HOLLY HOLLAND DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	060467	NY
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	060467	NY

General Provider Information

NPI Number	:	1083101315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY HOLLAND DDS

Provider Business Mailing Address
First Line	:	97 E 4TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-9002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 E 4TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-9002
Country	:	US
Telephone Number	:	212-292-3848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	07/10/2024

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Directions to “ HOLLY HOLLAND DDS” Practice Location

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