Provider Demographics
NPI:1356682728
Name:DR STEPHEN C HOLMES, DDS, LLC
Entity Type:Organization
Organization Name:DR STEPHEN C HOLMES, DDS, LLC
Other - Org Name:STEPHEN HOLMES, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-400-4539
Mailing Address - Street 1:189 GREENBRIAR BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7234
Mailing Address - Country:US
Mailing Address - Phone:504-400-4539
Mailing Address - Fax:
Practice Address - Street 1:189 GREENBRIAR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7234
Practice Address - Country:US
Practice Address - Phone:504-400-4539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty