Provider Demographics
NPI:1144774464
Name:HOLIDAY, KERRIE (RDH)
Entity Type:Individual
Prefix:MISS
First Name:KERRIE
Middle Name:
Last Name:HOLIDAY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38865 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6812
Mailing Address - Country:US
Mailing Address - Phone:248-879-7755
Mailing Address - Fax:
Practice Address - Street 1:38865 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6812
Practice Address - Country:US
Practice Address - Phone:248-879-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902009660124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist