Provider Demographics
NPI:1114959277
Name:HOLMAN, DEE JO (DDS)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:JO
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6531 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8342
Mailing Address - Country:US
Mailing Address - Phone:620-786-4667
Mailing Address - Fax:
Practice Address - Street 1:6531 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8342
Practice Address - Country:US
Practice Address - Phone:620-786-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202728122300000X
KS5951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U11279Medicare UPIN
U11279Medicare UPIN