MEDICARE: STEPHEN THOMAS HOLMES 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	2901019454	MI

General Provider Information

NPI Number	:	1871617290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN THOMAS HOLMES DDS

Provider Business Mailing Address
First Line	:	23800 ORCHARD LAKE RD
Second Line	:	STE 106
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-2560
Country	:	US
Telephone Number	:	248-755-5700
Fax Number	:	248-471-7383

Provider Business Practice Location Address
First Line	:	12871 E JEFFERSON AVE
Second Line	:	STE C
City	:	DETROIT
State	:	MI
Zip	:	48215-2754
Country	:	US
Telephone Number	:	313-822-4200
Fax Number	:	313-822-0944

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	05/03/2012

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