Individual
DR. SHANNA COUCH HOLLIDAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
251 MORTON BLVD, HAZARD, KY 41701-9470
(606) 439-1079
(606) 439-3878
Mailing address
310 DOCTORS ROW, CHAVIES, KY 41727-8954
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7633
KY
1223P0221X
Pediatric Dentistry
7633
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45003811
—
KY
05
—
60000262
—
KY
Enumeration date
02/21/2007
Last updated
07/12/2012
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