Provider Demographics
NPI:1154051100
Name:HOLSEN, ERIK STEFAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:STEFAN
Last Name:HOLSEN
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 1:400 TREVISO GRAND CIR UNIT 211
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3296
Mailing Address - Country:US
Mailing Address - Phone:864-517-4136
Mailing Address - Fax:
Practice Address - Street 1:12152 MERCADO DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1155
Practice Address - Country:US
Practice Address - Phone:941-786-0897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL269811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice