Healthcare Provider Details

I. General information

NPI: 1144604083
Provider Name (Legal Business Name): TODD MARK HOLMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 E COLFAX AVE 150
AURORA CO
80010-2371
US

IV. Provider business mailing address

1105 MAPLE CT
BROOMFIELD CO
80020-1049
US

V. Phone/Fax

Practice location:
  • Phone: 303-344-2273
  • Fax: 303-344-2268
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00202576
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: