Provider Demographics
NPI:1437703964
Name:HOLLY HILL DENTAL CARE
Entity Type:Organization
Organization Name:HOLLY HILL DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-563-3208
Mailing Address - Street 1:102 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-2160
Mailing Address - Country:US
Mailing Address - Phone:843-563-3208
Mailing Address - Fax:
Practice Address - Street 1:303 BUNCH FORD RD
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:SC
Practice Address - Zip Code:29059-8401
Practice Address - Country:US
Practice Address - Phone:803-496-9012
Practice Address - Fax:803-496-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty