Provider Demographics
NPI:1386794154
Name:OSHEA, HOLLY LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LYNN
Last Name:OSHEA
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 1:410 NW 18TH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2262
Mailing Address - Country:US
Mailing Address - Phone:503-274-2612
Mailing Address - Fax:
Practice Address - Street 1:1880 LANCASTER DR NE STE 109
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1065
Practice Address - Country:US
Practice Address - Phone:503-375-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDL81731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry