Individual
SHALISE MARIE HOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
4001 N MULFORD RD, LOVES PARK, IL 61111-6949
(815) 877-6453
Mailing address
4001 N MULFORD RD, LOVES PARK, IL 61111-6949
(815) 877-6453
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021.002884
IL
Other
Enumeration date
09/05/2018
Last updated
09/05/2018
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