Provider Demographics
NPI:1871935130
Name:VREEBURG, HOLLY
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:VREEBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8741 BROOKS RD S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8741 BROOKS RD S
Practice Address - Street 2:SUITE 201
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7853
Practice Address - Country:US
Practice Address - Phone:707-579-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist