Healthcare Provider Details

I. General information

NPI: 1215040720
Provider Name (Legal Business Name): MICHELLE R HOLMES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117H VILLAGE RD NE
LELAND NC
28451-7413
US

IV. Provider business mailing address

6211 TERRAPIN CT
WILMINGTON NC
28409-2045
US

V. Phone/Fax

Practice location:
  • Phone: 910-371-5664
  • Fax:
Mailing address:
  • Phone: 910-409-2307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number150586
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-026310
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8744
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: