Provider Demographics
NPI:1366451932
Name:HOLDER, MARY WENDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:WENDY
Last Name:HOLDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3431
Mailing Address - Country:US
Mailing Address - Phone:256-234-6841
Mailing Address - Fax:256-329-8509
Practice Address - Street 1:980 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3431
Practice Address - Country:US
Practice Address - Phone:256-234-6841
Practice Address - Fax:256-329-8509
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL07818Medicare UPIN
AL0005450246Medicare UPIN