Provider Demographics
NPI:1093874547
Name:HOLM, PAMELA JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JEAN
Last Name:HOLM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:TEREICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1969 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1526
Mailing Address - Country:US
Mailing Address - Phone:651-690-3557
Mailing Address - Fax:
Practice Address - Street 1:1835 COUNTY ROAD C W
Practice Address - Street 2:#220
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1352
Practice Address - Country:US
Practice Address - Phone:651-636-2123
Practice Address - Fax:651-636-2614
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND106981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice