Provider Demographics
NPI:1114957214
Name:HOLMES, ALVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:HOLMES
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 1:1939 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2209
Mailing Address - Country:US
Mailing Address - Phone:315-479-7019
Mailing Address - Fax:315-422-7018
Practice Address - Street 1:1939 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2209
Practice Address - Country:US
Practice Address - Phone:315-479-7019
Practice Address - Fax:315-422-7018
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036338-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY036338-1OtherLICENSE NO.
NY01277949Medicaid