Provider Demographics
NPI:1689007494
Name:OKERSTROM, HOLLY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANN
Last Name:OKERSTROM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 NW ROLLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3519
Mailing Address - Country:US
Mailing Address - Phone:541-757-0082
Mailing Address - Fax:541-757-7325
Practice Address - Street 1:2605 NW ROLLING GREEN DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3519
Practice Address - Country:US
Practice Address - Phone:541-757-0082
Practice Address - Fax:541-757-7325
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8662122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist