Healthcare Provider Details

I. General information

NPI: 1437661220
Provider Name (Legal Business Name): KENNETH L. HOLDER, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E CALAVERAS BLVD
MILPITAS CA
95035-5412
US

IV. Provider business mailing address

420 E CALAVERAS BLVD
MILPITAS CA
95035-5412
US

V. Phone/Fax

Practice location:
  • Phone: 408-262-6800
  • Fax: 408-262-6007
Mailing address:
  • Phone: 408-262-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25152
License Number StateCA

VIII. Authorized Official

Name: DR. KENNETH L. HOLDER
Title or Position: PRESIDENT
Credential: DDS
Phone: 408-262-6800