Provider Demographics
NPI:1447586243
Name:GORSEN, HOLLY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANN
Last Name:GORSEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:ELDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1017 EAST LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360
Mailing Address - Country:US
Mailing Address - Phone:856-692-4670
Mailing Address - Fax:856-692-3068
Practice Address - Street 1:1017 EAST LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-692-4670
Practice Address - Fax:856-692-3068
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02418000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist