Provider Demographics
NPI:1790190304
Name:HALDEMAN-COLLINS, HOLLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:HALDEMAN-COLLINS
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 1:190 MARIE ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:WV
Mailing Address - Zip Code:26456-1132
Mailing Address - Country:US
Mailing Address - Phone:304-873-1401
Mailing Address - Fax:304-873-1542
Practice Address - Street 1:109 MARIE STREET
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:WV
Practice Address - Zip Code:26456-1132
Practice Address - Country:US
Practice Address - Phone:304-873-1401
Practice Address - Fax:304-873-1542
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV41071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice