Provider Demographics
NPI:1124324876
Name:MCKNIGHT, HOLLY ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANN
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:BOUREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:305 W 12TH AVE
Mailing Address - Street 2:POSTLE HALL, RM 4129
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1267
Mailing Address - Country:US
Mailing Address - Phone:614-292-4927
Mailing Address - Fax:
Practice Address - Street 1:305 W 12TH AVE
Practice Address - Street 2:POSTLE HALL, RM 4129
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-292-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist