Provider Demographics
NPI:1104188366
Name:HOLMAN, THOMAS M (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:HOLMAN
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 1:6215 S 37TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1618
Mailing Address - Country:US
Mailing Address - Phone:479-466-6725
Mailing Address - Fax:
Practice Address - Street 1:1510 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6810
Practice Address - Country:US
Practice Address - Phone:479-271-2299
Practice Address - Fax:479-271-6419
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice