Healthcare Provider Details

I. General information

NPI: 1184406498
Provider Name (Legal Business Name): DAEJA S HOLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7504 ABERDEEN AVE
CLEVELAND OH
44103-2042
US

IV. Provider business mailing address

7504 ABERDEEN
CLEVELAND OH
44103
US

V. Phone/Fax

Practice location:
  • Phone: 216-336-7011
  • Fax:
Mailing address:
  • Phone: 216-336-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: