Provider Demographics
NPI:1164710331
Name:KURT M. HOLMES DDS PC
Entity Type:Organization
Organization Name:KURT M. HOLMES DDS PC
Other - Org Name:HEALTHY SMILES DENTISTRY, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:MONEX
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-619-0347
Mailing Address - Street 1:3285 HACKS CROSS RD
Mailing Address - Street 2:SUITE 103 & 104
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8918
Mailing Address - Country:US
Mailing Address - Phone:901-619-0347
Mailing Address - Fax:
Practice Address - Street 1:3285 HACKS CROSS RD
Practice Address - Street 2:SUITE 103 & 104
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8918
Practice Address - Country:US
Practice Address - Phone:901-619-0347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000079081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1275602716OtherNPI