MEDICARE: RONALD E HOLMAN, DDS,PA

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	04111	FL

General Provider Information

NPI Number	:	1174565881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD E HOLMAN, DDS,PA

Provider Business Mailing Address
First Line	:	25520 STATE ROAD 46
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-9526
Country	:	US
Telephone Number	:	352-735-2212
Fax Number	:	352-735-5844

Provider Business Practice Location Address
First Line	:	25520 STATE ROAD 46
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-9526
Country	:	US
Telephone Number	:	352-735-2212
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RONALD E HOLMAN
Credential	:	DDS
Telephone Number	:	352-735-2211

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	04/24/2008

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