Provider Demographics
NPI:1407028640
Name:HOLLIDAY, LINDA ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:HOLLIDAY
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 1:119 N M ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-3419
Mailing Address - Country:US
Mailing Address - Phone:561-582-2446
Mailing Address - Fax:561-588-4480
Practice Address - Street 1:119 N M ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-3419
Practice Address - Country:US
Practice Address - Phone:561-582-2446
Practice Address - Fax:561-588-4480
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL590206OtherUNITED CONCORDIA
FL64681OtherBLUE CROSS BLUE SHIELD