Healthcare Provider Details

I. General information

NPI: 1194663112
Provider Name (Legal Business Name): CASEY HOLMES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6238 ARDENNES STREET BUILDING #C-6238
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

9500 ANNAPOLIS RD STE A7
LANHAM MD
20706-2061
US

V. Phone/Fax

Practice location:
  • Phone: 910-432-8170
  • Fax:
Mailing address:
  • Phone: 301-577-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number13809
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: