Provider Demographics
NPI:1487826806
Name:HOLLERMAN, DAVIDA ANN (MS, DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVIDA
Middle Name:ANN
Last Name:HOLLERMAN
Suffix:
Gender:F
Credentials:MS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S JEFFERSON PL
Mailing Address - Street 2:5
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-5257
Mailing Address - Country:US
Mailing Address - Phone:901-679-6090
Mailing Address - Fax:901-525-5407
Practice Address - Street 1:525 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-1635
Practice Address - Country:US
Practice Address - Phone:877-664-8664
Practice Address - Fax:901-525-5407
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3206720Medicaid