Healthcare Provider Details

I. General information

NPI: 1174452585
Provider Name (Legal Business Name): DR. AUDREY HOLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 CEMETERY RD STE A
HILLIARD OH
43026-1106
US

IV. Provider business mailing address

2641 KENT RD
COLUMBUS OH
43221-3227
US

V. Phone/Fax

Practice location:
  • Phone: 614-682-8645
  • Fax:
Mailing address:
  • Phone: 614-581-4903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028448
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: