MEDICARE: DR. CHRISTOPHER A.S. HOLCOMB 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	1223G0001X	General Practice Dentistry	12013429A	IN

General Provider Information

NPI Number	:	1457978785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER A.S. HOLCOMB DDS

Provider Business Mailing Address
First Line	:	7150 ANDERSON DR APT 206
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-5808
Country	:	US
Telephone Number	:	812-241-9946
Fax Number	:

Provider Business Practice Location Address
First Line	:	4217 E 3RD ST
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-5550
Country	:	US
Telephone Number	:	812-332-2000
Fax Number	:

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

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	07/02/2020

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