MEDICARE: BDD FD RYAN K HOLMES DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1174491997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BDD FD RYAN K HOLMES DDS INC

Provider Business Mailing Address
First Line	:	333 W 1ST ST
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 W SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-4108
Country	:	US
Telephone Number	:	419-472-6645
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JAY JORBIN
Credential	:
Telephone Number	:	312-805-8590

Provider Enumeration Date	:	10/24/2025
Last Update Date	:	04/19/2026

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