Provider Demographics
NPI:1467613083
Name:RANDONE, HOLLY A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:A
Last Name:RANDONE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7531
Mailing Address - Country:US
Mailing Address - Phone:402-462-6557
Mailing Address - Fax:
Practice Address - Street 1:601 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-7531
Practice Address - Country:US
Practice Address - Phone:402-462-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300227661223P0221X
NE68741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry