Provider Demographics
NPI:1396820304
Name:CAPPS, HOLLY MARIE (RDA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:CAPPS
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5443 OLD NATCHEZ TRCE
Mailing Address - Street 2:
Mailing Address - City:PRIMM SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:38476-5003
Mailing Address - Country:US
Mailing Address - Phone:931-682-0012
Mailing Address - Fax:615-302-4201
Practice Address - Street 1:5073 COLUMBIA PIKE
Practice Address - Street 2:SUITE 240
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-8607
Practice Address - Country:US
Practice Address - Phone:615-902-4200
Practice Address - Fax:615-302-4201
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10827126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant