MEDICARE: RONALD E HOLMAN D.D.S.

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	4111	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174565881	OTHER	FL	NATIONAL PROVIDER IDENTIFIER (PRACTICE)

General Provider Information

NPI Number	:	1538336771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD E HOLMAN D.D.S.

Provider Business Mailing Address
First Line	:	25520 STATE ROAD 46
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-9526
Country	:	US
Telephone Number	:	352-735-2211
Fax Number	:	352-735-5844

Provider Business Practice Location Address
First Line	:	25520 STATE ROAD 46
Second Line	:
City	:	SORRENTO
State	:	FL
Zip	:	32776-9526
Country	:	US
Telephone Number	:	352-735-2211
Fax Number	:	352-735-5844

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/15/2008

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Directions to “ RONALD E HOLMAN D.D.S.” Practice Location

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