Provider Demographics
NPI:1952115685
Name:HOLLEY, KENYA (DDS)
Entity type:Individual
Prefix:
First Name:KENYA
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 SNUG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-1479
Mailing Address - Country:US
Mailing Address - Phone:252-619-7283
Mailing Address - Fax:
Practice Address - Street 1:529 SNUG HARBOR RD
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-1479
Practice Address - Country:US
Practice Address - Phone:252-619-7283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program