Provider Demographics
NPI:1881844082
Name:HOLLIDAY, SALLY GRANT (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:GRANT
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 REMUS DR
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691-4927
Mailing Address - Country:US
Mailing Address - Phone:864-723-5220
Mailing Address - Fax:
Practice Address - Street 1:11 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:EASTANOLLEE
Practice Address - State:GA
Practice Address - Zip Code:30538-3254
Practice Address - Country:US
Practice Address - Phone:864-723-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139471223X0400X
SC46211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics