Provider Demographics
NPI:1417017617
Name:HOLMES, DARIN WADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:WADE
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 1:707 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4444
Mailing Address - Country:US
Mailing Address - Phone:830-997-9505
Mailing Address - Fax:830-997-4865
Practice Address - Street 1:707 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4444
Practice Address - Country:US
Practice Address - Phone:830-997-9505
Practice Address - Fax:830-997-4865
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice