Healthcare Provider Details

I. General information

NPI: 1518194885
Provider Name (Legal Business Name): JOSHUA HOLCOMB D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 E MAIN ST
ADAMSVILLE TN
38310-2450
US

IV. Provider business mailing address

PO BOX 321
ADAMSVILLE TN
38310-0321
US

V. Phone/Fax

Practice location:
  • Phone: 731-632-3371
  • Fax: 731-632-5443
Mailing address:
  • Phone: 731-632-3371
  • Fax: 731-632-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8991
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: