| Shanna Couch Holliday | |
|
251 Morton Blvd Hazard KY 41701-9470 | |
| (606) 439-1079 | |
| Not Available |
| Full Name | Shanna Couch Holliday |
|---|---|
| Speciality | Dentist |
| Location | 251 Morton Blvd, Hazard, Kentucky |
| Authorized Official Name and Position | Shanna Holliday (OWNER) |
| Authorized Official Contact | 6064391069 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shanna Couch Holliday Po Box 799 Hazard KY 41702-0799 Ph: (606) 439-1079 | Shanna Couch Holliday 251 Morton Blvd Hazard KY 41701-9470 Ph: (606) 439-1079 |
| NPI Number | 1881965879 |
|---|---|
| Provider Enumeration Date | 01/23/2012 |
| Last Update Date | 01/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881965879 | NPI | - | NPPES |
| 60000262 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 7633 (Kentucky) | Primary |
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