Provider Demographics
NPI:1356629091
Name:HOLMES, RAYMOND SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:SCOTT
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 1:1855 TANNER WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8302
Mailing Address - Country:US
Mailing Address - Phone:865-717-7743
Mailing Address - Fax:865-717-6615
Practice Address - Street 1:1855 TANNER WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8302
Practice Address - Country:US
Practice Address - Phone:865-717-7743
Practice Address - Fax:865-717-6615
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN9313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist