Provider Demographics
NPI:1942377064
Name:HOLLADAY, DUSTIN B (DMD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:B
Last Name:HOLLADAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MIDDLEBURG DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579
Mailing Address - Country:US
Mailing Address - Phone:843-903-3111
Mailing Address - Fax:843-903-3110
Practice Address - Street 1:220 MIDDLEBURG DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:843-903-3111
Practice Address - Fax:843-903-3110
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist