Healthcare Provider Details

I. General information

NPI: 1578878856
Provider Name (Legal Business Name): JESSICA R HOLMES D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16708 RICHMOND HWY STE 115
DUMFRIES VA
22026-2770
US

IV. Provider business mailing address

12413 OLD YATES FORD RD
CLIFTON VA
20124-2023
US

V. Phone/Fax

Practice location:
  • Phone: 703-221-4040
  • Fax:
Mailing address:
  • Phone: 717-385-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401413200
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3898
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS038472
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: