Provider Demographics
NPI:1275602716
Name:HOLMES, KURT MONEK (DDS)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:MONEK
Last Name:HOLMES
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 1:7948 WINCHESTER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2311
Mailing Address - Country:US
Mailing Address - Phone:901-624-0440
Mailing Address - Fax:901-624-9771
Practice Address - Street 1:7948 WINCHESTER RD STE 108
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2311
Practice Address - Country:US
Practice Address - Phone:901-624-0440
Practice Address - Fax:901-624-9771
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice