Provider Demographics
NPI:1003812033
Name:HOLLY, LARA KIRSTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:KIRSTIN
Last Name:HOLLY
Suffix:
Gender:F
Credentials:DMD
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Mailing Address - Street 1:8355 WALNUT HILL LN
Mailing Address - Street 2:STE 125
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4237
Mailing Address - Country:US
Mailing Address - Phone:214-378-8868
Mailing Address - Fax:214-378-6182
Practice Address - Street 1:8355 WALNUT HILL LN
Practice Address - Street 2:STE 125
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4237
Practice Address - Country:US
Practice Address - Phone:214-378-8868
Practice Address - Fax:214-378-6182
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX195011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry