Provider Demographics
NPI:1871507319
Name:HOLLEY, IV, JAMES WHITEING (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WHITEING
Last Name:HOLLEY, IV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 EFFINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3416
Mailing Address - Country:US
Mailing Address - Phone:757-393-2401
Mailing Address - Fax:757-393-4462
Practice Address - Street 1:446 EFFINGHAM ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3416
Practice Address - Country:US
Practice Address - Phone:757-393-2401
Practice Address - Fax:757-393-4462
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0074311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA054734OtherBLUE CROSS BLUE SHIELD
VA054734OtherH.K.P.
VA106564Medicaid
VA145830OtherBC/BS FEDERAL
VA901912OtherUNITED CONCORDIA
VA118556OtherCIGNA
VA7431OtherDELTA DENTAL