Provider Demographics
NPI:1093922908
Name:ORMOND, GINA HOLLAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:HOLLAND
Last Name:ORMOND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 AIKEN HUNT CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8420
Mailing Address - Country:US
Mailing Address - Phone:803-419-9106
Mailing Address - Fax:
Practice Address - Street 1:1260 LEXINGTON DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-2176
Practice Address - Country:US
Practice Address - Phone:803-822-3450
Practice Address - Fax:803-822-3079
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ30538Medicaid