Provider Demographics
NPI:1326300773
Name:HOLMAN, KENNETH ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALAN
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:52 ARCH ST
Mailing Address - Street 2:SUITE NO 2
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1469
Mailing Address - Country:US
Mailing Address - Phone:650-366-5758
Mailing Address - Fax:650-366-0714
Practice Address - Street 1:52 ARCH ST
Practice Address - Street 2:SUITE NO 2
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1469
Practice Address - Country:US
Practice Address - Phone:650-366-5758
Practice Address - Fax:650-366-0714
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA235161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics