Provider Demographics
NPI:1093726424
Name:HOLCOMB, LORI KAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:KAY
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12611 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6313
Mailing Address - Country:US
Mailing Address - Phone:314-514-0660
Mailing Address - Fax:314-514-0601
Practice Address - Street 1:12611 OLIVE ST
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6313
Practice Address - Country:US
Practice Address - Phone:314-514-0660
Practice Address - Fax:314-514-0601
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0145941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice