Healthcare Provider Details

I. General information

NPI: 1174565881
Provider Name (Legal Business Name): RONALD E HOLMAN, DDS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25520 STATE ROAD 46
SORRENTO FL
32776-9526
US

IV. Provider business mailing address

25520 STATE ROAD 46
SORRENTO FL
32776-9526
US

V. Phone/Fax

Practice location:
  • Phone: 352-735-2212
  • Fax:
Mailing address:
  • Phone: 352-735-2212
  • Fax: 352-735-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number04111
License Number StateFL

VIII. Authorized Official

Name: DR. RONALD E HOLMAN
Title or Position: DENTIST
Credential: DDS
Phone: 352-735-2211