MEDICARE: DR. COLIN JUSTIN HOLMAN 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	5867	OK

General Provider Information

NPI Number	:	1902837388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLIN JUSTIN HOLMAN DDS

Provider Business Mailing Address
First Line	:	833 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-6005
Country	:	US
Telephone Number	:	405-735-6600
Fax Number	:	405-735-6674

Provider Business Practice Location Address
First Line	:	833 SW 119TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-6005
Country	:	US
Telephone Number	:	405-735-6600
Fax Number	:	405-735-6674

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/01/2010

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