Holly Street Dental, LLC

NPI #1669717393 in Canby, Oregon

Provider Information

NPI Number: 1669717393
Entity Type: Organization
Organization Name: Holly Street Dental, LLC
Primary Specialty: Dentist
Enumeration Date: Dec 6, 2012
Last Updated: Dec 6, 2012

Practice Location

Address: 300 N HOLLY ST
City: Canby
State: Oregon
ZIP Code: 97013-3739
Phone: (503) 266-1117

Authorized Official

Name: C STEVEN HAGLER
Title: DENTIST
Phone: (503) 266-1117

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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