MEDICARE: DR. BRUCE E HOLES D.M.D.

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	10,036	GA

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	:	1831184100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE E HOLES D.M.D.

Provider Business Mailing Address
First Line	:	22 W ROBERT TOOMBS AVE
Second Line	:
City	:	WASHINGTON
State	:	GA
Zip	:	30673-2107
Country	:	US
Telephone Number	:	706-678-4321
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 W ROBERT TOOMBS AVE
Second Line	:
City	:	WASHINGTON
State	:	GA
Zip	:	30673-1662
Country	:	US
Telephone Number	:	706-678-4300
Fax Number	:	706-678-1750

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	05/03/2022

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