Healthcare Provider Details

I. General information

NPI: 1659063725
Provider Name (Legal Business Name): JORDAN NICOLE HOLMES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N STEPHANIE ST STE 170
HENDERSON NV
89074-8998
US

IV. Provider business mailing address

175 N STEPHANIE ST STE 170
HENDERSON NV
89074-8998
US

V. Phone/Fax

Practice location:
  • Phone: 702-997-5958
  • Fax: 702-565-4878
Mailing address:
  • Phone: 702-997-5958
  • Fax: 702-565-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8451
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: