Provider Demographics
NPI:1710598321
Name:HAVENS, SYDNEY HOLLAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:HOLLAND
Last Name:HAVENS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SYDNEY
Other - Middle Name:L
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:80 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-5633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-5633
Practice Address - Country:US
Practice Address - Phone:270-534-4887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice