Provider Demographics
NPI:1730252818
Name:HOLLEY, MAUREEN M (DMD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:M
Last Name:HOLLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2087 SW DANFORTH CIR
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-7704
Mailing Address - Country:US
Mailing Address - Phone:772-283-2068
Mailing Address - Fax:
Practice Address - Street 1:2075 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4609
Practice Address - Country:US
Practice Address - Phone:772-288-9901
Practice Address - Fax:772-288-9981
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN127211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice