Provider Demographics
NPI:1568500627
Name:ASADI, HOLLY (DDS)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:ASADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MARIPOSA AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2660
Mailing Address - Country:US
Mailing Address - Phone:831-722-4292
Mailing Address - Fax:831-768-8580
Practice Address - Street 1:94 MARIPOSA AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2660
Practice Address - Country:US
Practice Address - Phone:831-722-4292
Practice Address - Fax:831-768-8580
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4211702OtherDENTI-CAL PROVIDER NUMBER