Provider Demographics
NPI:1972110336
Name:HOLIMAN, ALICIA KAY (RDH, BSDH, EPDH)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:KAY
Last Name:HOLIMAN
Suffix:
Gender:F
Credentials:RDH, BSDH, EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 SE 66TH WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-6217
Mailing Address - Country:US
Mailing Address - Phone:707-972-4640
Mailing Address - Fax:
Practice Address - Street 1:7460 SW HUNZIKER RD STE H
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8244
Practice Address - Country:US
Practice Address - Phone:503-521-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8076124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500785672Medicaid