Provider Demographics
NPI:1841638384
Name:HILL, HOLLY (DDS)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:HILL
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 1:3480 BUNKER LAKE BLVD NW STE 202
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-2086
Mailing Address - Country:US
Mailing Address - Phone:763-427-4780
Mailing Address - Fax:763-427-8471
Practice Address - Street 1:3480 BUNKER LAKE BLVD NW STE 202
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-2086
Practice Address - Country:US
Practice Address - Phone:763-427-4780
Practice Address - Fax:763-427-8471
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND132401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice