Healthcare Provider Details

I. General information

NPI: 1730173295
Provider Name (Legal Business Name): STEPHEN COLE HOLMES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 PRYTANIA ST SUITE 380
NEW ORLEANS LA
70115-3761
US

IV. Provider business mailing address

3715 PRYTANIA ST SUITE 380
NEW ORLEANS LA
70115-3761
US

V. Phone/Fax

Practice location:
  • Phone: 504-896-7435
  • Fax: 504-896-7437
Mailing address:
  • Phone: 504-896-7435
  • Fax: 504-896-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21063
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8620
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5923
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: