Provider Demographics
NPI:1083023444
Name:AGUIGAM, HOLLY KATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:KATHERINE
Last Name:AGUIGAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12773 CIJON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3024
Mailing Address - Country:US
Mailing Address - Phone:424-256-5192
Mailing Address - Fax:
Practice Address - Street 1:2619 CLAIREMONT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6634
Practice Address - Country:US
Practice Address - Phone:424-256-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist