Healthcare Provider Details

I. General information

NPI: 1467480491
Provider Name (Legal Business Name): STEVEN M HOLMES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 RED RD SUITE 101
SOUTH MIAMI FL
33143-5428
US

IV. Provider business mailing address

7600 RED RD SUITE 101
SOUTH MIAMI FL
33143-5428
US

V. Phone/Fax

Practice location:
  • Phone: 305-913-2474
  • Fax: 305-667-3503
Mailing address:
  • Phone: 305-913-2474
  • Fax: 305-667-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN8052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: