Provider Demographics
NPI:1598020406
Name:MICHAEL, HOLLY (DDS)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:MICHAEL
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 1:4027 COLONY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2420
Mailing Address - Country:US
Mailing Address - Phone:832-693-1193
Mailing Address - Fax:
Practice Address - Street 1:4027 COLONY OAKS DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2420
Practice Address - Country:US
Practice Address - Phone:832-693-1193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX281131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice