Provider Demographics
NPI:1326317090
Name:MARLON L HOLMES, DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARLON L HOLMES, DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLON
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-876-3313
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327
Mailing Address - Country:US
Mailing Address - Phone:318-876-3313
Mailing Address - Fax:318-876-3258
Practice Address - Street 1:915 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:COTTONPORT
Practice Address - State:LA
Practice Address - Zip Code:71327
Practice Address - Country:US
Practice Address - Phone:318-876-3313
Practice Address - Fax:318-876-3258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty