Provider Demographics
NPI:1205010816
Name:HOLMAN, CHARLES M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:HOLMAN
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 1:16336 WHITTIER BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2900
Mailing Address - Country:US
Mailing Address - Phone:562-943-2585
Mailing Address - Fax:
Practice Address - Street 1:16336 WHITTIER BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2900
Practice Address - Country:US
Practice Address - Phone:562-943-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics