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General NPI Number Information
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NPI Number | 1578878856
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Entity Type | Individual
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Provider Name | JESSICA R HOLMES D.D.S
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Gender | Female
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 16708 JEFFERSON DAVIS HWY STE 115
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City | DUMFRIES
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State | VA
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Zip | 22026-2770
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Country | US
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Telephone | 703-221-4040
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Fax |
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Provider Business Mailing Address
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Address Line | 12413 OLD YATES FORD RD
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City | CLIFTON
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State | VA
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Zip | 20124-2023
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Country | US
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Telephone | 717-385-6755
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS038472
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3898
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401413200
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License Number State | VA
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