Provider Demographics
NPI:1144604083
Name:HOLMAN, TODD MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MARK
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10401 E COLFAX AVE
Practice Address - Street 2:150
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-2371
Practice Address - Country:US
Practice Address - Phone:303-344-2273
Practice Address - Fax:303-344-2268
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist