Provider Demographics
NPI:1205129202
Name:MCMAHON, HOLLY MARIE (DDS)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:MCMAHON
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 1:250 FULLER ST. S.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379
Mailing Address - Country:US
Mailing Address - Phone:952-445-6657
Mailing Address - Fax:952-445-0674
Practice Address - Street 1:250 FULLER ST. S.
Practice Address - Street 2:SUITE 250
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379
Practice Address - Country:US
Practice Address - Phone:952-445-6657
Practice Address - Fax:952-445-0674
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist