Provider Demographics
NPI:1194939355
Name:HOLIDAY, SUSAN I (DMD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:I
Last Name:HOLIDAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MCNAMARA RD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1406
Mailing Address - Country:US
Mailing Address - Phone:845-354-1565
Mailing Address - Fax:
Practice Address - Street 1:102 MCNAMARA RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1406
Practice Address - Country:US
Practice Address - Phone:845-354-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0163261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice