MEDICARE: DR. MICHAEL HOLMBERG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	61260	KS
2	122300000X	Dentist	202562	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184007221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL HOLMBERG DDS

Provider Business Mailing Address
First Line	:	2221 E BIJOU ST STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-8009
Country	:	US
Telephone Number	:	719-576-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	6075 E PARKWAY DR STE 160
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-5413
Country	:	US
Telephone Number	:	720-795-7077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	06/05/2022

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