Healthcare Provider Details

I. General information

NPI: 1073437745
Provider Name (Legal Business Name): KYNDAL LEIGH HOLMES DDS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2222 E. 5TH ST.
SUPERIOR WI
54880-3709
US

IV. Provider business mailing address

2222 E. 5TH ST.
SUPERIOR WI
54880-3709
US

V. Phone/Fax

Practice location:
  • Phone: 715-392-1955
  • Fax: 715-392-1935
Mailing address:
  • Phone: 715-392-1955
  • Fax: 715-392-1935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6002210-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: