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General NPI Number Information
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NPI Number | 1801010046
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Entity Type | Individual
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Provider Name | MICHAEL NEIL HOLDEN LD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 25052 104TH AVE SE STE G
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City | KENT
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State | WA
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Zip | 98030-6853
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Country | US
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Telephone | 253-813-8000
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Fax | 253-813-8007
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Provider Business Mailing Address
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Address Line | 25052 104TH AVE SE STE G
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City | KENT
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State | WA
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Zip | 98030-6853
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Country | US
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Telephone | 253-813-8000
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Fax | 253-813-8007
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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 | 122400000X
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Taxonomy Name | Denturist
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License Number | DN 60153167
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122400000X
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Taxonomy Name | Denturist
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License Number | DT-DO-10111220
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License Number State | OR
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