Healthcare Provider Details

I. General information

NPI: 1790854032
Provider Name (Legal Business Name): LISA KIM HOLST D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 50TH ST
WEST DES MOINES IA
50265-7990
US

IV. Provider business mailing address

275 50TH ST
WEST DES MOINES IA
50265-7990
US

V. Phone/Fax

Practice location:
  • Phone: 515-224-9899
  • Fax:
Mailing address:
  • Phone: 515-224-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7380
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: