Provider Demographics
NPI:1316397722
Name:SISLER, HOLLY ELIZBETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ELIZBETH
Last Name:SISLER
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 1:170 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-1383
Mailing Address - Country:US
Mailing Address - Phone:301-895-8076
Mailing Address - Fax:301-895-8022
Practice Address - Street 1:170 MILLER ST
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-1383
Practice Address - Country:US
Practice Address - Phone:301-895-8076
Practice Address - Fax:301-895-8022
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4216122300000X
MD16648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0136367000Medicaid