Healthcare Provider Details

I. General information

NPI: 1013005750
Provider Name (Legal Business Name): MICHAEL HOLMES SR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S 5TH ST
GADSDEN AL
35901-5102
US

IV. Provider business mailing address

404 S 5TH ST
GADSDEN AL
35901-5102
US

V. Phone/Fax

Practice location:
  • Phone: 256-546-4604
  • Fax: 256-546-4674
Mailing address:
  • Phone: 256-546-4604
  • Fax: 256-546-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4930
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: