Provider Demographics
NPI:1043438799
Name:HOLM, RICHARD NATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NATHAN
Last Name:HOLM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 DE FOREST RD
Mailing Address - Street 2:STE B
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-2771
Mailing Address - Country:US
Mailing Address - Phone:831-384-2562
Mailing Address - Fax:831-384-2962
Practice Address - Street 1:3154 DE FOREST RD
Practice Address - Street 2:STE B
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-2771
Practice Address - Country:US
Practice Address - Phone:831-384-2562
Practice Address - Fax:831-384-2962
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA339381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice