Healthcare Provider Details

I. General information

NPI: 1336494954
Provider Name (Legal Business Name): LINDSAY ANN HOLMAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LINDSAY ANN RAYBURN

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32280 FIVE MILE RD
LIVONIA MI
48154-6112
US

IV. Provider business mailing address

32280 FIVE MILE RD
LIVONIA MI
48154-6112
US

V. Phone/Fax

Practice location:
  • Phone: 734-425-7010
  • Fax:
Mailing address:
  • Phone: 734-425-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901020688
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: