Provider Demographics
NPI:1568686798
Name:HOLLIDAY, SEAN R (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:R
Last Name:HOLLIDAY
Suffix:
Gender:M
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 1:98-1247 KAAHUMANU ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5311
Mailing Address - Country:US
Mailing Address - Phone:808-485-1177
Mailing Address - Fax:
Practice Address - Street 1:98-1247 KAAHUMANU ST
Practice Address - Street 2:SUITE 202
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5311
Practice Address - Country:US
Practice Address - Phone:808-485-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI20771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000255075OtherHMSA INSURANCE PROVIDER #
HI2077OtherHDS INSURANCE PROVIDER #
HI01632510OtherUNITEDCONCORDIA PROVIDER#