Provider Demographics
NPI:1609492610
Name:HOLLEY, KEVIN BARTLETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BARTLETT
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4519
Mailing Address - Country:US
Mailing Address - Phone:252-702-9043
Mailing Address - Fax:
Practice Address - Street 1:107 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5937
Practice Address - Country:US
Practice Address - Phone:252-321-2500
Practice Address - Fax:252-321-0248
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11784122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist