Healthcare Provider Details

I. General information

NPI: 1053400820
Provider Name (Legal Business Name): SCOTT EUGENE HOLMES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 SHALLOWFORD RD
CHATTANOOGA TN
37421-5406
US

IV. Provider business mailing address

4500 8TH DIVISION RD
COLUMBIA SC
29207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 423-893-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6340
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: