Organization
HOLLEY FAMILY DENTISTRY FREDERICKSBURG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICHOLE P LIVESAY (OFFICE MANAGER)
(540) 785-5885
Entity
Organization
Contact information
Practice address
974 BRAGG RD, FREDERICKSBURG, VA 22407-6979
(540) 785-5885
Mailing address
974 BRAGG RD, FREDERICKSBURG, VA 22407-6979
(540) 785-5885
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7431
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6239
—
VA
Enumeration date
11/14/2008
Last updated
11/14/2008
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