Provider Demographics
NPI:1396836318
Name:HOLMES, CHARLES WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
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 1:4723 AVE. J
Mailing Address - Street 2:
Mailing Address - City:FT. MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-9511
Mailing Address - Country:US
Mailing Address - Phone:319-372-4882
Mailing Address - Fax:319-372-4882
Practice Address - Street 1:4723 AVE. J
Practice Address - Street 2:
Practice Address - City:FT. MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-9511
Practice Address - Country:US
Practice Address - Phone:319-372-4882
Practice Address - Fax:319-372-4882
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA62861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice