Provider Demographics
NPI:1972660330
Name:HALLIDAY, HOLLY ANNE (DDS)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANNE
Last Name:HALLIDAY
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 1:251 FAIRVIEW EAST
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N8M 2R4
Mailing Address - Country:CA
Mailing Address - Phone:519-776-7551
Mailing Address - Fax:
Practice Address - Street 1:247 PEARL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8502
Practice Address - Country:US
Practice Address - Phone:802-863-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist