Provider Demographics
NPI:1992383640
Name:HOLLY DENTAL PLLC
Entity type:Organization
Organization Name:HOLLY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VINEET
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-707-8941
Mailing Address - Street 1:1050 E BROADWAY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647
Mailing Address - Country:US
Mailing Address - Phone:903-707-8941
Mailing Address - Fax:903-765-5309
Practice Address - Street 1:1050 E BROADWAY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647
Practice Address - Country:US
Practice Address - Phone:903-707-8941
Practice Address - Fax:903-765-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30165OtherTEXAS STATE BOARD OF DENTAL EXAMINERS