Provider Demographics
NPI:1295929289
Name:HAHN, HOLLY LAURA (RDH)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LAURA
Last Name:HAHN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 ROSEMONT AVE NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3924
Mailing Address - Country:US
Mailing Address - Phone:503-371-7297
Mailing Address - Fax:
Practice Address - Street 1:898 ROSEMONT AVE NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3924
Practice Address - Country:US
Practice Address - Phone:503-371-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-01
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5155124Q00000X
CA22881124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist