Provider Demographics
NPI:1386452050
Name:HOLLEY, KUANA N (RDH)
Entity type:Individual
Prefix:
First Name:KUANA
Middle Name:N
Last Name:HOLLEY
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 1:3317 RUECKERT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2922
Mailing Address - Country:US
Mailing Address - Phone:540-498-1428
Mailing Address - Fax:
Practice Address - Street 1:7801 YORK RD STE 303
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7449
Practice Address - Country:US
Practice Address - Phone:410-337-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6454124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist