Provider Demographics
NPI:1407089055
Name:HOLLIDAY ORTHODONTICS
Entity Type:Organization
Organization Name:HOLLIDAY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:HOLLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:864-723-5220
Mailing Address - Street 1:11 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EASTANOLLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30538-3254
Mailing Address - Country:US
Mailing Address - Phone:706-827-0088
Mailing Address - Fax:
Practice Address - Street 1:11 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:EASTANOLLEE
Practice Address - State:GA
Practice Address - Zip Code:30538-3254
Practice Address - Country:US
Practice Address - Phone:706-827-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013947261QD0000X
SC4621261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental