Provider Demographics
NPI:1598915605
Name:BIDWELL, HOLLY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LYNN
Last Name:BIDWELL
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 1:2411 CROFTON LN
Mailing Address - Street 2:SUITE 19A
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1304
Mailing Address - Country:US
Mailing Address - Phone:410-451-3299
Mailing Address - Fax:
Practice Address - Street 1:2411 CROFTON LN
Practice Address - Street 2:SUITE 19A
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1304
Practice Address - Country:US
Practice Address - Phone:410-451-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126651223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics