Provider Demographics
NPI:1346554839
Name:HOLMES, DANETTE ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:ELIZABETH
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-1903
Mailing Address - Country:US
Mailing Address - Phone:718-893-3560
Mailing Address - Fax:
Practice Address - Street 1:1245 SOUTHERN BLVD.
Practice Address - Street 2:
Practice Address - City:BRONX NY
Practice Address - State:NY
Practice Address - Zip Code:10459
Practice Address - Country:US
Practice Address - Phone:718-893-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043916-11223G0001X
FLDN130911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice